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Published on: February 6, 2021
Haemophilus influenza endophthalmitis after pterygium surgery
Anton M Kolomeyer1, Neelakshi Bhagat, David S Chu
1Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101-1709, USA.
Objective:
To describe a case of Haemophilus influenza endophthalmitis after pterygium surgery.
Method:
Retrospective case report.
Results:
A 50-year-old Hispanic male underwent a pterygium excision with amniotic membrane graft (AMG) and 0.02% MMC. He presented 3.5 months later with severe pain, yellow-white discharge, and decreased visual acuity for several days, and conjunctival injection for 3 months. Repair of perforation with a corneal graft was performed. Intravitreal antibiotics were administered. Many β-lactamase negative H. influenza organisms were cultured from the vitreous aspirate. The vitritis significantly improved and hypopyon resolved over the next week. The patient underwent surgery for a combined tractional and rhegmatogenous RD 9 days later. The endophthalmitis resolved; however, he developed proliferative vitreoretinopathy (PVR) with redetached retina 21 days after the initial RD repair. He underwent subsequent surgery. Six months later, AMG was performed for recurrent corneal erosion with a large epithelial defect. At last follow-up, the vision remains at hand motions, the retina is flat, there is mild corneal decompensation, the eye is soft to palpation, and there are signs of early phthisis.
Conclusions:
A prospective study to identify the optimal concentration and period of application for MMC, as well as patient characteristics resulting in the highest clinical benefit-to-risk ratio may be warranted.
Insights
Haemophilus influenza endophthalmitis occurred 3.5 months after pterygium surgery with amniotic membrane graft and mitomycin-C (MMC). Prompt treatment resolved the infection but led to severe vision loss and complications.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Pterygium surgery often involves adjunctive treatments like mitomycin-C (MMC) and amniotic membrane grafts (AMG).
- Postoperative endophthalmitis is a rare but serious complication following ocular surgery.
Observation:
- A 50-year-old male developed severe endophthalmitis with *Haemophilus influenza* 3.5 months after pterygium excision with AMG and MMC.
- The patient presented with pain, discharge, decreased visual acuity, and conjunctival injection.
Findings:
- Culture of vitreous aspirate confirmed *Haemophilus influenza* (beta-lactamase negative).
- Initial treatment with intravitreal antibiotics led to resolution of vitritis and hypopyon.
- Despite infection resolution, the patient experienced retinal detachment, proliferative vitreoretinopathy, and ultimately severe vision impairment (hand motions) with early phthisis.
Implications:
- This case highlights a delayed presentation of *Haemophilus influenza* endophthalmitis after pterygium surgery.
- The findings suggest a potential need to re-evaluate the long-term safety profile of MMC and AMG in pterygium surgery.
- Further prospective studies are warranted to determine optimal MMC concentrations and application durations to maximize benefit-risk ratio.
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