Citrobacter koseri Endophthalmitis Following Intravitreal Fluocinolone Acetonide Implant Injection

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Citrobacter koseri is a gram-negative bacillus typically found in the gut.
• Exogenous endophthalmitis caused by C. koseri is rare, often linked to ocular trauma and associated with poor visual outcomes.

Purpose of the Study:

• To report a rare case of C. koseri endophthalmitis following an intravitreal injection for diabetic macular edema.
• To highlight the successful management and visual outcome in such a case.

Main Methods:

• A 76-year-old patient developed endophthalmitis after a fluocinolone acetonide intravitreal injection.
• Diagnostic vitreous biopsy and therapeutic intravitreal vancomycin and ceftazidime injections were administered.
• C. koseri was identified in the vitreous sample culture.

Main Results:

• The patient's endophthalmitis resolved following treatment with intravitreal antibiotics.
• Pre-infection visual acuity was restored without the need for vitrectomy.
• C. koseri was successfully eradicated from the ocular cavity.

Conclusions:

• Intravitreal antibiotic therapy can be effective in treating C. koseri endophthalmitis following intravitreal injections.
• Prompt diagnosis and treatment are crucial for favorable visual outcomes in rare cases of bacterial endophthalmitis.
• This case suggests that C. koseri endophthalmitis may occur in the absence of direct ocular trauma.