Propionibacterium acnes DNA from an explanted intraocular lens detected by polymerase chain reaction in a case of chronic pseudophakic endophthalmitis

Culture-Negative C acnes Endophthalmitis Following Implantation of a Phakic Implantable Collamer Lens

Purpose:

This work describes a case of Cutibacterium acnes (formerly Propionibacterium acnes) endophthalmitis following a posterior-chamber, phakic, Implantable Collamer Lens (ICL) surgery.

Methods:

A 34-year-old previously healthy woman presented with chronic unilateral iritis 8 months after bilateral ICL surgery. Original testing revealed no cause for the iritis with normal culture, serology, and autoimmune testing results.

Results:

Follow-up revealed C acnes by polymerase chain reaction on vitrectomy samples. Complete resolution of symptoms was achieved following removal of the implant, lensectomy, and intravitreal antibiotics.

Conclusions:

We believe this is the first reported case of postphakic ICL C acnes endophthalmitis. It highlights the utility of polymerase chain reaction in cases of chronic uveitis.

An Atypical Presentation of Propionibacterium Acnes Endophthalmitis Following Cataract Surgery

Purpose:

To describe a case with an unusual presentation of Propionibacterium acnes ( P acnes) with ultimately a good visual outcome.

Methods:

A case report with review of approaches to P acnes endophthalmitis.

Results:

We describe a patient with an unusual presentation of P acnes of panuveitis with white, circular preretinal lesions without intracapsular deposits. Diagnosis was made from cultures from pars plana vitrectomy. Eventually, she was definitively managed with capsulectomy, repositioning of her intraocular lens via sutureless intrascleral fixation, and intravitreal vancomycin injection.

Conclusion:

This is a report of P acnes endophthalmitis presenting with discrete preretinal lesions where surgical and medical management lead to a complete resolution of uveitis and symptoms after a 3-year follow up where the patient’s final visual acuity was Snellen 20/20 OU.

Massilia timonae as cause of chronic endophthalmitis following cataract surgery

This is the first report of chronic postoperative endophthalmitis caused by Massilia timonae. The gram-negative bacillus was isolated from a patient who developed chronic endophthalmitis after cataract extraction. The microorganism was cultured on brain-heart infusion broth and identified using the 16S rRNA sequence analysis. Biochemically, the organism was positive for catalase and oxidase and negative for arginine dihydrolase. It was pansensitive to β-lactams, fluoroquinolones, aminoglycosides, and trimethoprim-sulfamethoxazole but resistant to aztreonam. Massilia timonae is a new bacterium implicated in postoperative chronic endophthalmitis. Eubacterial polymerase chain reaction was useful in identifying M timonae because phenotyping testing and conventional algorithms could not identify it.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

AIM

To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE).

METHODS

Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach.

RESULTS

Six of 9 patients were male. The average patients' age was (60±8.1) years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3) weeks. The average presenting visual acuity was 0.3±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9) weeks. In all patients, the inflammation subsided after surgery.

CONCLUSION

Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE.

A Case of Delayed-Onset Propionibacterium acnes Endophthalmitis after Cataract Surgery with Implantation of a Preloaded Intraocular Lens

Purpose

To report a case of delayed-onset endophthalmitis after implantation of a preloaded intraocular lens (IOL) and examine the surgically removed IOL by scanning electron microscopy (SEM).

Case

A 77-year-old female underwent uneventful phacoemulsification and aspiration with preloaded silicone IOL implantation. Since intraocular inflammation unexpectedly worsened 1 month after the surgery, she was referred to our hospital. Her visual acuity was hand motion in the left eye. Hypopyon and fibrin formation were observed in the anterior chamber. A diagnosis of postoperative delayed-onset endophthalmitis was made, and vitrectomy with anterior chamber wash-out was performed. As intraocular inflammation remained unchanged postoperatively, an additional surgery with IOL removal was performed. We cultivated the surgically removed samples of aqueous humor and vitreous fluid under both aerobic and anaerobic conditions, performed 16S rDNA clone library analysis of these clinical samples, and examined the removed IOL by SEM.

Result

Inflammation subsided after the re-operation. Although cultures of aqueous and vitreous samples were negative, DNA of Propionibacterium acnes was detected in the aqueous humor. The SEM images showed that the rod bacteria and biofilm-like material formed on the tip of the IOL haptic.

Conclusion

Delayed-onset endophthalmitis may occur after uneventful implantation of a preloaded IOL. The SEM findings suggested that the tip of the preloaded IOL haptic might scratch bacteria which adhered to the tip of the injector nozzle when the IOL was inserted into the anterior chamber. In some cases with delayed-onset endophthalmitis, IOL removal is needed to eliminate the bacteria which adhere to the tip of the IOL haptic.

Endophthalmitis: A review of recent trends

Endophthalmitis is a feared complication of trauma, surgical procedures and septicemia. Although uncommon, its potential for significant visual loss is well recognized. Especially over the past decade, complicated surgeries and medical techniques have increased and seriously ill patients are being sustained in ever increasing numbers. New pathogens are being recognized and known ones reclassified thanks to advances in molecular analysis. Continuously evolving PCR methodologies also add a new dimension to the diagnosis of infectious endophthalmitis. As well, medical literature is now truly international, encompassing studies from around the world that expand our understanding of ocular infectious disease. This report reviews some of these changes as they relate to endophthalmitis and particularly to the spectrum of organisms involved.

[Chronic postoperative endophthalmitis]

Chronic postoperative endophthalmitis designates delayed-onset postoperative endophthalmitis appearing more than two weeks after surgery, revealed by chronic intraocular inflammation with phases of inflammatory recurrence, which, at the beginning of the disease course, is partially sensitive to local corticosteroid treatment. It differs therefore from acute endophthalmitis in the immediate postoperative phase, from acute differed endophthalmitis after filtrating surgery, which appears years after the surgery, and from endogenous endophthalmitis. The most frequent presentation is granulomatous uveitis, often hypertonic, in an eye operated for cataract, presenting phases of recurrence sensitive to corticosteroid therapy but which recurs as soon as treatment is interrupted. Whitish condensations in plaques on the posterior capsule suggest the diagnosis and over several months the vitreous becomes inflamed. Ocular samples allow cytological analysis of an infectious process and bacteriological analysis in culture and with PCR. Treatment includes lavage of the sac with vancomycin and can be associated with posterior capsulectomy and intravitreal injections of antibiotics possibly associated with systemic antibiotic therapy. Treatment is prolonged because of the slow replication of the microorganisms involved. In approximately one-third of cases, the implant, the capsule, and the sac must be removed over 360° to permanently halt the intraocular infection. The diagnosis and specific treatment should be as early as possible since the aggressiveness of the treatment required is correlated with the time to management of the infection.