Staphylococcus lugdunensis endophthalmitis after intravitreal injection: a case series

To report the clinical features and visual and anatomical outcomes in three patients with Staphylococcus lugdunensis endophthalmitis after intravitreal injection.

This study was a retrospective, interventional case series conducted at a single, tertiary care retina referral practice under the approval of Western Institutional Review Board. Records of three eyes with culture-positive S. lugdunensis endophthalmitis after intravitreal injection with Lucentis or Avastin were reviewed. All patients were treated between November 2011 and March 2012.

All three patients developed symptoms of endophthalmitis 2 to 3 days after intravitreal injection and were culture positive for S. lugdunensis. Initial visual acuity ranged from 20/200 to light perception. Final visual acuity ranged from 20/100 to hand motion. Duration of follow-up ranged from 4 months to 10 months. One patient was treated with vitreous tap and injection of ceftazidime and vancomycin. Two patients underwent immediate vitrectomy and injection of intravitreal ceftazidime and vancomycin. One patient developed a retinal detachment requiring pars plana vitrectomy and silicone oil. All three patients demonstrated an early and aggressive course.

This case series demonstrates that S. lugdunensis endophthalmitis can follow an aggressive course atypical for coagulase-negative organisms. Accurate identification of S. lugdunensis is important for management and prognosis. However, identification of S. lugdunensis is confounded by potential false-positive coagulase tests and the lack of routine speciation by microbiology laboratories.