Role of intrastromal vancomycin in recalcitrant corneal abscess after phacoemulsification

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Cataract surgery, specifically phacoemulsification, carries a risk of serious complications like side port infections and corneal abscesses.
• Topical antibacterial drugs are standard treatment, but intrastromal antibacterial injections are rarely reported due to pharmacokinetic considerations.
• Fungal keratitis is typically managed with intrastromal antifungal agents, establishing a precedent for localized drug delivery.

Observation:

• A case of corneal abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) occurred post-phacoemulsification.
• The patient received conventional therapy alongside intrastromal vancomycin injection.

Findings:

• The corneal abscess demonstrated a positive response to the combined treatment regimen.
• Intrastromal vancomycin proved effective as an adjunct therapy in this challenging MRSA infection.

Implications:

• This case underscores the critical role of meticulous postoperative hygiene in preventing severe ocular infections.
• Anterior segment optical coherence tomography (AS-OCT) is valuable for monitoring treatment progress in such cases.
• Intrastromal vancomycin injection represents a potentially crucial adjunctive treatment for severe post-cataract surgery corneal abscesses unresponsive to conventional therapy.