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Chronic Postoperative Endophthalmitis Associated With Propionibacterium acnes

Chronic Postoperative Endophthalmitis Associated With Propionibacterium acnes Abstract • We present two cases of Propionibacterium acnes endophthalmitis that confirm the association of this organism with a delayed onset and chronic and indolent intraocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. The clinical, microbiologic, and histopathologic features of these cases suggest that the organism can be sequestered in the capsular bag, which may make this entity difficult to diagnose. We conclude that complete capsulectomy may be required if inflammation persists after conventional treatment for endophthalmitis, which may include pars plana vitrectomy, partial capsulectomy, and antibiotic therapy. Sterile postoperative uveitis is a diagnosis of exclusion. We stress the importance of appropriate microbiologic investigation in all cases of postsurgical inflammation, even if the onset is delayed until several months after surgery. References 1. Forster RK: Etiology and diagnosis of bacterial postoperative endophthalmitis . Ophthalmology 1978;85:320-326.Crossref 2. Pflugfelder SC, Zwickey TA, Foster RK, et al: Exogenous fungal endophthalmitis . Ophthalmology 1986;93( (suppl) ):85.Crossref 3. Ellingson FT: Complications with the Choyce Mark VII anterior chamber lens implant (uveitis-glaucoma-hyphema) . Am Intraocul Implant Soc J 1977;3:199-205.Crossref 4. Keates RH, Ehrlich DR: 'Lenses of chance' complication of anterior chamber implants . Ophthalmology 1978;85:408-414.Crossref 5. Obstbaum SA, Galin MA: Cystoid macular edema and ocular inflammation: The corneoretinal inflammatory syndrome . Trans Ophthalmol Soc UK 1979;99:187-191. 6. Meltzer DW: Sterile hypopyon following intraocular lens surgery . Arch Ophthalmol 1980;98:100-104.Crossref 7. Stark WJ, Rosenblum P, Maumenee AE, et al: Postoperative inflammatory reactions to intraocular lenses sterilized with ethylene-oxide . Ophthalmology 1980;87:385-389.Crossref 8. Apple DJ, Mamalis N, Steinmetz RL, et al: Phacoanaphylactic endophthalmitis associated with extracapsular cataract extraction and posterior chamber intraocular lens . Arch Ophthalmol 1984;102:1528-1532.Crossref 9. Abrahams IW: Diagnosis and surgical management of phacoanaphylactic uveitis following extracapsular cataract extraction with intraocular lens implantation . J Am Intraocul Implant Soc 1985;11:444-447.Crossref 10. McMahon MS, Weiss JS, Riedel KG, et al: Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation . Br J Ophthalmol 1985;69:836-840.Crossref 11. Wohl LG, Lucier AC, Kline OR Jr, et al: Pseudophakic phacoanaphylactic endophthalmitis . Ophthalmic Surg 1986;17:234-237. 12. Meisler DM, Palestine AG, Vastine DW, et al: Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation . Am J Ophthalmol 1986;102:733-739. 13. Jaffe GJ, Whitcher JP, Biswell R, et al: Propionibacterium acnes endophthalmitis seven months after extracapsular cataract extraction and intraocular lens implantation . Ophthalmic Surg 1986;17:791-793. 14. Smith RE: Inflammation after cataract surgery . Am J Ophthalmol 1986;102:788-790.Crossref 15. Webster GF, Leyden JJ, Musson RA, et al: Susceptibility of Propionibacterium acnes to killing and degradation by human neutrophils and monocytes in vitro . Infect Immun 1985;49:116-121. 16. De Young LM, Spires DA, Ballaron BS, et al: Acne-like chronic inflammatory activity of Propionibacterium acnes preparations in an animal model: Correlation with ability to stimulate the reticuloendothelial system . J Invest Dermatol 1985;85:225-258.Crossref 17. Maguire HC Jr, Cipriano D: Immunopotentiation of cell-mediated hypersensitivity by Corynebacterium parvum (Propionibacterium acnes) . Int Arch Allergy Appl Immunol 1983;70:34-39.Crossref 18. Wang WLL, Everett ED, Johnson M, et al: Susceptibility of Propionibacterium acnes to 17 antibiotics . Antimicrob Agents Chemother 1977;11:171-173.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Chronic Postoperative Endophthalmitis Associated With Propionibacterium acnes

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1987.01060090057026
Publisher site
See Article on Publisher Site

Abstract

Abstract • We present two cases of Propionibacterium acnes endophthalmitis that confirm the association of this organism with a delayed onset and chronic and indolent intraocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. The clinical, microbiologic, and histopathologic features of these cases suggest that the organism can be sequestered in the capsular bag, which may make this entity difficult to diagnose. We conclude that complete capsulectomy may be required if inflammation persists after conventional treatment for endophthalmitis, which may include pars plana vitrectomy, partial capsulectomy, and antibiotic therapy. Sterile postoperative uveitis is a diagnosis of exclusion. We stress the importance of appropriate microbiologic investigation in all cases of postsurgical inflammation, even if the onset is delayed until several months after surgery. References 1. Forster RK: Etiology and diagnosis of bacterial postoperative endophthalmitis . Ophthalmology 1978;85:320-326.Crossref 2. Pflugfelder SC, Zwickey TA, Foster RK, et al: Exogenous fungal endophthalmitis . Ophthalmology 1986;93( (suppl) ):85.Crossref 3. Ellingson FT: Complications with the Choyce Mark VII anterior chamber lens implant (uveitis-glaucoma-hyphema) . Am Intraocul Implant Soc J 1977;3:199-205.Crossref 4. Keates RH, Ehrlich DR: 'Lenses of chance' complication of anterior chamber implants . Ophthalmology 1978;85:408-414.Crossref 5. Obstbaum SA, Galin MA: Cystoid macular edema and ocular inflammation: The corneoretinal inflammatory syndrome . Trans Ophthalmol Soc UK 1979;99:187-191. 6. Meltzer DW: Sterile hypopyon following intraocular lens surgery . Arch Ophthalmol 1980;98:100-104.Crossref 7. Stark WJ, Rosenblum P, Maumenee AE, et al: Postoperative inflammatory reactions to intraocular lenses sterilized with ethylene-oxide . Ophthalmology 1980;87:385-389.Crossref 8. Apple DJ, Mamalis N, Steinmetz RL, et al: Phacoanaphylactic endophthalmitis associated with extracapsular cataract extraction and posterior chamber intraocular lens . Arch Ophthalmol 1984;102:1528-1532.Crossref 9. Abrahams IW: Diagnosis and surgical management of phacoanaphylactic uveitis following extracapsular cataract extraction with intraocular lens implantation . J Am Intraocul Implant Soc 1985;11:444-447.Crossref 10. McMahon MS, Weiss JS, Riedel KG, et al: Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation . Br J Ophthalmol 1985;69:836-840.Crossref 11. Wohl LG, Lucier AC, Kline OR Jr, et al: Pseudophakic phacoanaphylactic endophthalmitis . Ophthalmic Surg 1986;17:234-237. 12. Meisler DM, Palestine AG, Vastine DW, et al: Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation . Am J Ophthalmol 1986;102:733-739. 13. Jaffe GJ, Whitcher JP, Biswell R, et al: Propionibacterium acnes endophthalmitis seven months after extracapsular cataract extraction and intraocular lens implantation . Ophthalmic Surg 1986;17:791-793. 14. Smith RE: Inflammation after cataract surgery . Am J Ophthalmol 1986;102:788-790.Crossref 15. Webster GF, Leyden JJ, Musson RA, et al: Susceptibility of Propionibacterium acnes to killing and degradation by human neutrophils and monocytes in vitro . Infect Immun 1985;49:116-121. 16. De Young LM, Spires DA, Ballaron BS, et al: Acne-like chronic inflammatory activity of Propionibacterium acnes preparations in an animal model: Correlation with ability to stimulate the reticuloendothelial system . J Invest Dermatol 1985;85:225-258.Crossref 17. Maguire HC Jr, Cipriano D: Immunopotentiation of cell-mediated hypersensitivity by Corynebacterium parvum (Propionibacterium acnes) . Int Arch Allergy Appl Immunol 1983;70:34-39.Crossref 18. Wang WLL, Everett ED, Johnson M, et al: Susceptibility of Propionibacterium acnes to 17 antibiotics . Antimicrob Agents Chemother 1977;11:171-173.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1987

References