Kytococcus schroeteri Chronic Post-Operative Endophthalmitis After Cataract Surgery: The First Report of Ocular...

To report the first case of Kytococcus schroeteri ocular infection manifesting as chronic post-operative endophthalmitis (CPOE) following routine phacoemulsification with intraocular lens (IOL) implantation. This gram-positive bacterium is recognised as a cause of hardware infections in immunocompetent hosts, such as prosthetic cardiac valves, ventriculoperitoneal shunts, and orthopaedic hardware, often necessitating surgical removal of the infected prostheses for cure.

Case report and literature review.

A 64-year-old male with a history of uncomplicated cataract extraction and IOL insertion had multiple presentations over 6 years, with relapsing-remitting intraocular inflammation with multiple negative vitreous cultures treated as non-infectious panuveitis. An eventual positive vitreous culture for K. schroeteri led to a diagnosis of CPOE, which was successfully treated with vitrectomy, removal of IOL, and intravitreal vancomycin injections. However, advanced vision loss occurred due to secondary glaucoma.

K. schroeteri is a novel cause of CPOE, which is typically attributed to other low virulence organisms. As with infections of non-ocular implanted hardware by K. schroeteri, surgical removal of the infected IOL-capsule complex was required for cure. The CPOE diagnosis requires a combination of high index of suspicion and culture of vitreous and capsular material. The role of IOL removal for the treatment of CPOE is discussed.