Cataract wound infection and endophthalmitis treated with partial conjunctival pedicle flap and pars plana vitrectomy

Abstract

Introduction: Corneal wound infection is an infrequent complication of cataract surgery that can progress to endophthalmitis. Surgical treatment of endophthalmitis associated with microbial keratitis traditionally involves therapeutic penetrating keratoplasty and pars plana vitrectomy (PPV). In this case report, we describe a patient with cataract wound infection and endophthalmitis treated with PPV and partial conjunctival pedicle flap surgery. Patient and Clinical Findings: A 74-year-old female patient complained of eye pain and decreased corrected distance visual acuity (CDVA) to 2/200 4 weeks after cataract surgery in the left eye. Examination revealed an infiltrate overlying her cataract wound with posterior segment inflammation consistent with endophthalmitis. Diagnosis, Intervention, and Outcomes: Vitreous culture revealed methicillin-resistant Staphylococcus aureus. The patient was initially treated with topical and intravitreal antibiotics but demonstrated signs of disease progression, so the patient underwent PPV with partial conjunctival pedicle flap surgery. One month postoperatively, CDVA was 20/80 with resolution of the infection and no evidence of recurrence at 6 months. Conclusions: In conjunction with PPV, conjunctival flap surgery may be an effective alternative to therapeutic penetrating keratoplasty in patients with cataract wound-associated microbial keratitis and endophthalmitis.