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

Hayashi, Yuji; Eguchi, Hiroshi; Miyamoto, Tatsuro; Inoue, M.; Mitamura, Yoshinori

doi:10.1159/000342460

Cited by 19 publications

(14 citation statements)

References 13 publications

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“…This treatment strategy allows the removal of localized infectious sources while leaving enough capsular support for the IOL(26) . If the conservative-IOL surgical treatment is not e cient, as observed in our case 1, removal of the entire CB and the IOL is required to eradicate all sites of intraocular infection (9,13,15,17,19,23,26,27,34,(43)(44)(45)(46)(47)(48)73,76). Surgical treatments were observed in 50% of this case series, which agrees with other studies that reported it in approximately 30% to 73% of cases (12,15,16,27,41).…”

Section: Discussionmentioning

confidence: 87%

Chronic Pseudophakic Endophthalmitis After Uneventful Phakoemulsification: A Case Series and Review of Litterature

Mili¹,

Braham

Kaouel³

et al. 2021

Preprint

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Purpose: To report a retrospective case series of patients with chronic post operative endophthalmitis (CPE) after uneventful phacoemulsification (PKE) with intraocular lens (IOL) implantation. Methods: this study was conducted between January 2011 and June 2020, including patients with delayed-onset endopthalmitis occurring at least 2 weeks after uneventful PKE+IOL. Diagnosis was based on typical clinical features associated or not to proven sample culture. Treatment was based on step-by-step management, depending on results of microbiology and response of treatment. It consisted in first line medical treatment with a two-approach intraocular and systemic antiobiotics, followed, if necessary, by a second line conservative-IOL surgical treatment with pars plana vitrectomy (PPV), and a third line non-conservative-IOL surgical treatment with re-PPV associated to IOL explantation. Results: Seven patients were included with a mean age of 62,5 years. Mean duration interval between cataract surgery and diagnosis of CPE was 31,3 weeks. All patients presented a decrease of visual acuity with white intracapsular plaques. Only one patient had positive IOL culture. Medical treatment was sufficient in three cases. In the four other cases, PPV with IOL explantation and total capsular bag removal was conducted. Mean final BCVA was 20/160 with a gain of 4 lines and was ≥ 20/40 in 4 cases. Conclusion: The diagnosis of CPE is still challenging especially for difficulties in isolating microorganisms. It should always be considered in cases of recurrent ocular inflammation resistant to conventional treatment in operated eyes. Non-conservative IOL surgical treatment may be directly necessary in severe cases.

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Section: Discussionmentioning

confidence: 87%

Chronic Pseudophakic Endophthalmitis After Uneventful Phakoemulsification: A Case Series and Review of Litterature

Mili¹,

Braham

Kaouel³

et al. 2021

Preprint

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“…Moreover, C. acnes resistance to fluoroquinolones develops in an anaerobic environment [ 6 ], and therefore may be promoted by its sequestration within an intracapsular plaque. In addition, biofilm formation by C. acnes confers resistance to antibiotics and promotes the production of virulence factors [ 21 , 22 ]. Interestingly, the antibiotic rifampin is known to improve the penetration of vancomycin through biofilms [ 23 ], and oral rifampin has excellent intraocular penetration in humans [ 24 ].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Postoperative Endophthalmitis Caused by Cutibacterium (Formerly Propionibacterium) Acnes: Case Series and Review

Fowler

Miller

Yan

et al. 2021

Case Rep Ophthalmol

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We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes). This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven C. acnesfrom December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5–17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3–15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone (n = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (n = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics (n = 1). Follow-up treatments included IOL removal (n = 2), intravitreal antibiotics (n = 1), and topical antibiotics (n = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by C. acnes(n = 120) are listed. A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by C. acnesis characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.

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“…Literature has reported delayed onset postoperative infection after the implantation of preloaded IOL [ 12 , 13 ]. However, none of the patients developed postoperative infection in the follow up period of six months.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of semi-preloaded intraocular lens delivery system

Rajesh¹

2019

rjo

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Purpose: In this study, we aimed to evaluate the single surgeon experience of semipreloaded intraocular lens (IOL) delivery system. Methods: Phacoemulsification was performed under topical anesthesia by temporal clear corneal incision. CT Lucia hydrophobic IOL was injected through semi-preloaded IOL system in the capsular bag. Two hundred patients (200 eyes) were included in the study. The main outcome measures were ease of implantation, intraoperative and postoperative complications, postoperative centration, and visual acuity. Data on successful implantation and complications were collected prospectively. Results: Correct IOL delivery was achieved in 193 out of 200 patients (96.5%). Four patients (2%) required intrawound rotation of the injector to place the leading haptic in the capsular bag. Two patients (1%) had anteroposterior rotation of the IOL and one patient (0.5%) had total posterior rotation of IOL. Other problems noted were trapped trailing haptic (n=2,1%), improper loading of IOL (n=3,1.5%) and stretch marks on the optic of IOL (n=4,2%). None of the patients had iris trauma or posterior capsular rupture during the implantation and manipulation of the IOL. The mean incision size after completion of implantation of IOL was 2.82 mm (+ 0.02), which achieved sutureless closure. None of the patients developed postoperative infection. Conclusion: Implantation of CT Lucia 601 PY IOL with the semi preloaded system led to minor complications and gave satisfactory visual results.

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

Cited by 19 publications

References 13 publications

Chronic Pseudophakic Endophthalmitis After Uneventful Phakoemulsification: A Case Series and Review of Litterature

Chronic Pseudophakic Endophthalmitis After Uneventful Phakoemulsification: A Case Series and Review of Litterature

Postoperative Endophthalmitis Caused by <b><i>Cutibacterium</i></b> (Formerly <b><i>Propionibacterium</i></b>) Acnes: Case Series and Review

Evaluation of semi-preloaded intraocular lens delivery system

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