Successful treatment of endogenous endophthalmitis with extensive subretinal abscess: a case report

Abstract

BackgroundEndogenous endophthalmitis could lead to a devastating outcome without a prompt and appropriate management. We report a case of advanced endogenous Klebsiella pneumoniae endophthalmitis with extensive subretinal abscess that was successfully treated with a vitrectomy.Case presentationA systemically well 61-year-old man complained of ocular pain and visual decrease in his right eye for eighteen days. Ophthalmic examination showed dense inflammation in the anterior chamber and vitreous body. Systemic investigations discovered diabetes and no specific site of systemic infection was found after hospitalization. The inflammation continued to worsen after the intravitreal antibiotic injection. Therefore, a pars plana vitrectomy combined with phacoemulsification was performed. Intraoperatively, a white elevated, fluffy mass with the overlying retinal whitening and necrosis was revealed in superior periphery. In addition to this, extensive retinal hemorrhages and five adjacent subretinal whitish masses with exudative retinal detachment were observed in the posterior pole and inferior quadrants, which were suggestive of extensive subretinal abscess with intense overlying retinal inflammation. The excision of white fluffy mass superiorly was performed without retinotomy and aspiration of extensive subretinal abscess. The polymerase chain reaction of vitreous samples was positive for Klebsiella pneumonia. Intravitreal 2 mg/0.1 ml ceftazidime were repeated. Nine days after the surgery, the inflammation significantly subsided and the retina reattached. The patient was in a stable condition at subsequent visit eight months later.ConclusionThe delay in an accurate diagnosis and treatment caused extensive subretinal abscess combined with endogenous endophthalmitis. The treatment modality of subretinal abscess is typically individualized to the patient’s presentation. If the retina overlying the abscess is not necrotic, the extensive subretinal abscess can quickly absorbed after vitrectomy, retinotomy with aspiration of the abscess should be avoided to decrease the risk of retinal detachment.

Endogenous Endophthalmitis Caused by <b><i>Klebsiella pneumoniae</i></b>: A Ten-Year Retrospective Study in Western China

“…Due to the relatively small number of case series in most reports, there are not yet any guidelines on the management of this disease [9, 11, 12]. The therapeutic approaches and effects vary substantially among different reports and studies [10, 13, 14]. One decision tree analysis showed that the presence of K. pneumoniae was an independent factor associated with poor ocular outcomes of EE [15].…”

Metastatic endophthalmitis - Has the trend of causative organism changed in the modern antibiotic era - A Systematic Review

“…The patient was treated with intravitreal ceftazidime, PPV, retinotomy and retinal abscess drainage. But the patient’s visual outcome was only HM [ 34 ].…”

Sub-tenon’s vancomycin injection for subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis: a case report and literature review.

“…13 There is no clear consensus regarding the treatment of subretinal abscesses, and management is generally individualized for the patient's presentation. 5 Commonly used first-line treatment options for bacterial subretinal abscess include systemic antibiotics with intravitreal antibiotic injections. Additional options include pars plana vitrectomy with intravitreal antibiotics with or without retinotomy or retinectomy to drain the abscess.…”