Intralesional antibiotic injection using 41G needle for the management of subretinal abscess in endogenous endophthalmitis

Abstract

BackgroundPresence of subretinal abscess in endogenous endophthalmitis indicates a more severe form of infection. Available reports indicate variable response to standard treatment with systemic, intravitreal pharmacotherapy and vitreous surgery. There are no reports citing the possible role of intralesional antibiotic therapy in managing subretinal abscess.Case presentationA 30 year old lady presented with features of endogenous endophthalmitis and subretinal abscess. Presenting vision was finger counting close to face. Despite prompt initiation of systemic antibiotics and intravitreal injection, no response was noted. 25G pars plana vitrectomy was performed along with injection of vancomycin directly into the subretinal abscess, using a 41G needle. Postoperative course was uneventful and the abscess showed signs of rapid resolution. Visual acuity improved to 6/24.ConclusionIntralesional pharmacotherapy may be safe and effective in the treatment of subretinal abscess associated with endogenous endophthalmitis.

Metastatic subretinal abscess in a patient with perinephric abscess

“…[ 9 ] Venkateshet al used a 41-G translocation needle to make a self-sealing small retinotomy to deliver drugs in subretinal lesion. [ 10 ] One of the previous case reports described metastatic choroidal abscess in a diabetic patient with Staphylococcal aureus associated renal abscess which was managed with systemic antibiotics and showed improvement in the abscess, but later presented with choroidal neovascularisation, vitreous hemorrhage and pre retinal hemorrhage. [ 11 ]…”

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

“…Post-operative the abscess absorbed rapidly. Self-sealing small retinotomy created with a 41G translocation needle can be safely used to deliver drugs in a subretinal lesion decreasing the chance of proliferative vitreoretinopathy and retinal detachment [ 6 ].…”

Evaluation of rhegmatogenous retinal detachments using Optos ultrawide field fundus fluorescein angiography and comparison with ETDRS 7 field overlay

“…Ultrawide field imaging (Optos) has been used to evaluate various posterior segment disorders including dystrophies, 7 , 8 , 9 intraocular inflammation, 1 , 10 , 11 and intraocular 12 /periocular infection. 13 Optos has also been used to image RRDs before and after retinal reattachment surgery.…”