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Histology of retina overlying bacterial subretinal abscess and implications for treatment
John B Christoforidis1, Scott M Warden, Gault M Farrell
1From the *Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston; †Eye Care for the Adirondacks, Plattsburgh, New York; and ‡Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston.
Purpose:
To evaluate the state of the retina overlying a subretinal abscess and its contents by histopathologic analysis and electron microscopy (EM) and to determine implications for treatment.
Methods:
Case report of a patient with a subretinal abscess secondary to Klebsiella pneumoniae infection who underwent pars plana vitrectomy, PPL, endolaser, retinectomy, abscess drainage, and retinal biopsy. The retinal biopsy was analyzed histologically using special stains, and EM of the abscess contents was performed.
Results:
Postoperatively, the retina remained attached, and the patient regained visual acuity of 20/60. Culture of the vitrectomy specimen yielded K. pneumoniae. Retinal biopsy revealed a partially intact inner retina with destruction of the outer retinal layers in the setting of acute inflammation. Results of gram, Grocott-Gomori methenamine-silver nitrate, and acid-fast staining of the retinal biopsy specimen were negative. EM of the abscess contents revealed cellular debris with scattered inflammatory cells but no bacteria.
Conclusion:
This case demonstrates that aggressive surgical management of a subretinal abscess due to K. pneumoniae in an eye can result in useful vision. Management included retinectomy of the retina overlying the abscess that revealed photoreceptor destruction with intraretinal inflammation. Drainage of a subretinal abscess without removal of the overlying retina may limit treatment effectiveness and spare retina that is not functional.
Insights
Aggressive surgery for Klebsiella pneumoniae subretinal abscesses can preserve vision. Retinectomy over the abscess revealed photoreceptor destruction, indicating non-functional retina that benefits from removal.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Surgical Pathology
Background:
- Subretinal abscesses pose a significant threat to vision.
- Klebsiella pneumoniae is a known cause of intraocular infections.
- Understanding retinal state overlying abscesses is crucial for treatment.
Purpose of the Study:
- To histopathologically analyze the retina overlying a subretinal abscess.
- To examine abscess contents using electron microscopy (EM).
- To determine surgical treatment implications.
Main Methods:
- A case report detailing pars plana vitrectomy, retinectomy, abscess drainage, and retinal biopsy.
- Histopathologic analysis with special stains and EM of abscess contents.
- Culture of vitrectomy specimen for pathogen identification.
Main Results:
- Patient achieved 20/60 visual acuity postoperatively.
- Klebsiella pneumoniae was identified in the vitrectomy specimen.
- Retinal biopsy showed inner retina integrity but outer retinal destruction; EM revealed inflammatory debris, not bacteria.
Conclusions:
- Aggressive surgical management, including retinectomy, can yield useful vision in subretinal abscess cases.
- Retinectomy over the abscess revealed photoreceptor destruction and intraretinal inflammation.
- Removing non-functional, inflamed overlying retina is key to effective treatment.
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