Delayed-Onset Post-Keratoplasty Endophthalmitis Caused by Vancomycin-Resistant Enterococcus faeciumHernandez-Camarena J.C. · Bautista-de Lucio V.M. · Navas A. · Ramirez-Miranda A. · Graue-Hernandez E.O.
Departments of aCornea and Refractive Surgery, and bOcular Microbiology, Instituto de Oftalmologia ‘Conde de Valenciana’, Mexico City, Mexico
Background: Vancomycin-resistant Enterococcus (VRE) endophthalmitis after penetrating keratoplasty (PKP) is very rare, the management is a challenge due to both the pattern of antibiotic resistance and the aggressive nature of the infectious process. We report the first delayed-onset case of VRE endophthalmitis after PKP. Materials and Methods: Case report of a 51-year-old female with a 7-week history of PKP who arrived at the emergency room with signs and symptoms of endophthalmitis. Initial visual acuity was light perception, and a posterior pole exam was not possible due to the intense vitreous reaction. Mode B ultrasound was used to assess the posterior pole. The patient underwent pars plana vitrectomy and received intravitreous antibiotics. Results: Vitreous stains and cultures were positive for Enterococcus faecium resistant to vancomycin. Donor rim cultures and viral PCR were negative. Treatment was carried out by repeated intravitreal antibiotics and systemic linezolid. Clinical improvement was seen after the second dose of intravitreous antibiotics and systemic linezolid, but visual acuity remained at light perception consistent with the ischemic changes observed in the posterior pole. Conclusion: VRE endophthalmitis might be associated with positive donor rim cultures. Prompt use of systemic linezolid in addition to intravitreous antibiotics is recommendable, but even with prompt treatment, visual prognosis is guarded.
Enrique O. Graue-Hernandez, MD
Department of Cornea and Refractive Surgery
Instituto de Oftalmologia ‘Conde de Valenciana’
Chimalpopoca 14, Cuauhtémoc 06800, Mexico City (Mexico)
Published online: October 24, 2012
Number of Print Pages : 5
Number of Figures : 2,
Case Reports in Ophthalmology
Vol. 3, No. 3, Year 2012 (Cover Date: September - December)
Journal Editor: Loewenstein A. (Tel Aviv)
ISSN: 1663-2699 (Print), eISSN: 1663-2699 (Online)
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