Multidrug-resistant Staphylococcus hominis endophthalmitis after cataract surgery: A case report

Postoperative endophthalmitis is a rare but vision-threatening complication of cataract surgery. Multidrug-resistant organisms present additional therapeutic challenges.

We report a 52-year-old man who underwent uncomplicated phacoemulsification for posterior subcapsular cataract. On the first postoperative day, visual acuity was 8/10, but inflammation gradually appeared without the classic signs of endophthalmitis. On the fifth postoperative day, the patient's vision deteriorated significantly, reaching 1/10, accompanied by a strong inflammatory reaction in the anterior chamber. A pars plana vitrectomy was performed and vancomycin and ceftazidime were administered intravitreally. Staphylococcus hominis, resistant to most common antibiotics but sensitive to gentamicin, was isolated from the vitreous culture. The medication was modified accordingly, with topical gentamicin and oral doxycycline, under daily close monitoring. One month later, cystoid macular edema appeared, which was successfully treated with acetazolamide, topical corticosteroids, and bromfenac. Three months after surgery, the patient's vision had returned to 9/10 without any permanent damage.

Early surgical intervention, culture-guided therapy, and intensive follow-up can preserve vision even in postoperative endophthalmitis due to multidrug-resistant organisms.