A Case of Rhegmatogenous Retinal Detachment at Late Stage following Endogenous Bacterial Endophthalmitis

Abstract

Purpose: To report a case of rhegmatogenous retinal detachment in the late stage, despite the fact that it had previously been halted after intravitreal injection of an antimicrobial agent against endogenous bacterial endophthalmitis (EBE). Case: This study involved a 62-year-old male who had previously been diagnosed with septicemia due to liver abscess and the detection of Klebsiella pneumoniae in a culture of his liver abscess, and who underwent ophthalmic examination after his conjunctival hyperemia had failed to improve. Visual acuity could not be measured due to his general condition being poor and his declining level of consciousness. Slit lamp examination revealed bilateral iritis and cataracts, and the fundus was invisible due to vitreous opacity. Ultrasonic B-mode examination showed subretinal abscess and exudative retinal detachment, leading to the diagnosis of EBE. Vitreous injections of antibiotics were administered to both of his eyes. His right eye became affected by phthisis bulbi, but the condition in his left eye subsided, leaving a scarred lesion near the macula. However, complete retinal detachment occurred in his left eye approximately 10 months after the vitreous injection. During vitreous surgery, proliferative membrane formation was observed in the posterior pole area, and an irregular retinal break was detected in the scar margin caused by the traction of the proliferative membrane. After vitreous surgery, the retina was reattached under silicone oil. Conclusion: In cases of EBE, even if the inflammation has previously subsided, strict follow-up examinations are necessary, since complications such as rhegmatogenous retinal detachment may occur at a late stage.

Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy

“…Retinal necrosis with tangential traction of retinal membranes can lead to formation of retinal breaks and rhegmatogenous RD. Tori et al reported a rapid progression of proliferative vitreoretinopathy after endogenous bacterial endophthalmitis caused by meningitis [2,22,23]. The results of our study can verify this point of late onset RD and of necessary strict follow-ups.…”

“…Exogenous is mostly postoperative (e.g., cataract surgery), but may also be post-traumatic or related to organisms with an ability to penetrate intact corneas. It can be classified as either culture-positive or culture-negative (sterile) [1,2]. and further stratified into an acute form (within 6 weeks after surgery) which is the most common [3] and a delayed-onset form (more than 6 weeks after surgery).…”

Retinal Detachment After Endophthalmitis: Risk Factors and Outcomes

“… 6 , 8 Though seldom mentioned, RD may occur as a result of membranous scar tissue formation even after the inflammation has subsided. 10 Unlike the majority of patients with primary, non-complex rhegmatogenous retinal detachment, patients who develop RD after endophthalmitis generally have a poor visual prognosis, with up to two-thirds of all patients achieving a best corrected visual acuity (BCVA) of 20/400 or less even after surgical repair. 11 …”

Analysis of retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy

“…Retinal necrosis with tangential traction of retinal membranes can lead to formation of retinal breaks and rhegmatogenous RD. Tori et al reported a rapid progression of proliferative vitreoretinopathy after endogenous bacterial endophthalmitis caused by meningitis 2,19,20 . The results of our study can verify this point of late onset RD and of necessary strict follow ups.…”

“…Exogenous is mostly postoperative (e.g., cataract surgery), but may also be posttraumatic or related to organisms with an ability to penetrate intact corneas. It can be classi ed as either culture-positive or culture-negative (sterile) 1,2 . and further strati ed into an acute form (within 6 weeks after surgery) which is the most common 3 and a delayed-onset form (more than 6 weeks after surgery).…”