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Infectious scleritis after pars plana vitrectomy because of methicillin-resistant Staphylococcus aureus resistant to

Vahid Feiz1, Daniel E Redline

  • 1Department of Ophthalmology and Vision Science, University of California, Davis Medical Center, Sacramento, CA 95817, USA. vfeiz@ucdavis.edu

Cornea
|January 26, 2007
PubMed
Abstract

Insights

Infectious scleritis caused by methicillin-resistant Staphylococcus aureus (MRSA) can occur after eye surgery, even with standard antibiotic prophylaxis. Prompt treatment with vancomycin and erythromycin successfully resolved this serious post-operative complication.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Pars plana vitrectomy is a common surgical procedure for various retinal conditions.
  • Post-operative infectious scleritis is a rare but serious complication that can lead to vision loss.
  • Standard antibiotic prophylaxis, including topical fourth-generation fluoroquinolones, is typically used to prevent infection.

Observation:

  • A 72-year-old male developed scleral thinning and a subconjunctival abscess one month after pars plana vitrectomy.
  • Microbiological cultures of the scleral abscess identified methicillin-resistant Staphylococcus aureus (MRSA).
  • The isolated MRSA strain demonstrated resistance to fourth-generation fluoroquinolones but remained sensitive to vancomycin and erythromycin.

Findings:

  • Infectious scleritis can be caused by MRSA following ocular surgery, even when appropriate prophylactic antibiotics are administered.
  • The MRSA strain in this case was resistant to commonly used topical fluoroquinolones.
  • A treatment regimen combining topical vancomycin and systemic erythromycin was effective in resolving the infectious scleritis.

Implications:

  • This case highlights the potential for fluoroquinolone-resistant MRSA to cause post-operative infectious scleritis.
  • Ophthalmologists should consider MRSA in the differential diagnosis of infectious scleritis, especially in cases resistant to standard treatment.
  • Alternative or combination antibiotic therapies, such as vancomycin and erythromycin, may be necessary for treating resistant MRSA infections after ocular surgery.

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