Reactions 1680, p117 - 2 Dec 2017
Staphylococcal endophthalmitis: case report
A 60-year-old woman developed Staphylococcal
endophthalmitis following treatment with dexamethasone
[Ozurdex] and ofloxacin [dosages not stated and not all routes
The woman, who had a history of diabetic retinopathy, was
diagnosed with diabetic macular oedema (DME). She was
advised intravitreal bevacizumab injection in both the eyes.
Improvement was observed in left eye with best corrected
visual acuity (BCVA) 6/18, but DME in the right eye persisted.
Later, she was given intravitreal dexamethasone injection in
the right eye under aseptic precautions followed by
administration of ofloxacin eye drops 3 times a day for 3 days.
After 72 hours, she presented with redness and pain in the
right eye. Examination showed conjunctival congestion and
hypopyon with inflammatory membrane in the anterior
chamber. Grade 4 vitreous opacity with no view of the retina
was noted by fundus evaluation. B-scan ultrasonography
revealed increase in intravitreal echoes with intact
retinochoroidal complex, suggesting vitritis. She was
diagnosed with acute endophthalmitis.
The woman’s implant from vitreous cavity was removed by
pars plana vitrectomy (PPV). During same session
combination of tobramycin and vancomycin was
administered. Growth of coagulase-negative Staphylococcus
was observed on blood agar culture of vitreous sample. The
organism was also found to be resistant to ofloxacin and
levofloxacin. After operation, she was treated with tobramycin,
dexamethasone, gatifloxacin and cycloplegic eye drops. A
week after removal of the implant by vitrectomy improvement
was noted in BCVA 6/36, but DME persisted.
Author comment: "Our case demonstrated that acute
endophthalmitis can occur following dexamethasone
intravitreal implant." "In conclusion, our case demonstrated
that endophthalmitis can occur after intravitreal
dexamethasone implant, and postinjection prophylactic
antibiotic use could have been a risk factor."
Mahalingam P, et al. Drug-resistant coagulase-negative staphylococcal
endophthalmitis following dexamethasone intravitreal implant. Indian Journal of
Ophthalmology 65: 634-636, No. 7, Jul 2017. Available from: URL: http://
doi.org/10.4103/ijo.IJO_810_16 - India
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved