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Delayed-onset micrococcus luteus-induced postoperative endophthalmitis several months after cataract surgery: A case
Ki-Yup Nam1,2, Hong-Won Lee1,3
1Department of Ophthalmology, Chungnam National University, College of Medicine, Daejeon 35015, South Korea.
Background:
Micrococcus luteus (M. luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis. The aim of this study was to report a case of delayed-onset M. luteus-induced endophthalmitis that occurred several months after cataract surgery.
Case Summary:
A 78-year-old man presented with decreased vision, pain and redness in the right eye that had begun 3 days prior. He had undergone cataract surgery 4 mo prior. Visual acuity was counting fingers; slit-lamp examination revealed conjunctival injection, posterior corneal precipitates, anterior chamber inflammation (cell 4+), and hypopyon. Fundus examination revealed moderate vitreous haze. Urgent vitrectomy was performed for suspected infectious endophthalmitis, followed by vitreous irrigation with injections of antibiotics. On the postoperative day 1, anterior chamber cell decreased to 2+ and hypopyon was not observed on slit lamp examination. Six days postoperatively, the patient had recurrent eye pain, and the anterior chamber cell grade increased to 4+; hypopyon recurred in the anterior chamber, and whitish plaque was observed in the lens capsule. Therefore, the patient underwent intraocular lens (IOL) and lens capsule removal, followed by vitreous irrigation, antibiotics injection, and vitrectomy. M. luteus was identified from a lens capsule culture.
Conclusion:
In cases of delayed-onset M. luteus-induced endophthalmitis, early vitrectomy and removal of the IOL and lens capsule may be necessary.
Insights
Delayed-onset Micrococcus luteus endophthalmitis after cataract surgery is rare. Prompt vitrectomy and lens capsule removal are crucial for managing this severe infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Postoperative endophthalmitis following cataract surgery is a serious complication.
- Micrococcus luteus (M. luteus) is an uncommon cause of endophthalmitis, often presenting acutely.
- This case highlights a rare instance of delayed-onset M. luteus endophthalmitis months after surgery.
Observation:
- A 78-year-old male presented with decreased vision, pain, and redness 3 months post-cataract surgery.
- Initial symptoms included anterior chamber inflammation and hypopyon, treated with vitrectomy and antibiotics.
- Recurrence of severe inflammation and hypopyon necessitated IOL and lens capsule removal.
Findings:
- Cultures from the removed lens capsule identified Micrococcus luteus as the causative agent.
- The patient experienced a recurrence of endophthalmitis despite initial treatment, indicating the need for more aggressive intervention.
- Histopathological examination of the lens capsule revealed whitish plaque consistent with bacterial colonization.
Implications:
- Early diagnosis and intervention are critical for managing delayed-onset M. luteus endophthalmitis.
- Removal of the intraocular lens (IOL) and lens capsule is essential for eradicating the infection.
- This case underscores the importance of considering rare pathogens in persistent or recurrent postoperative endophthalmitis.
