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CHRONIC ACTINOMYCES NEUII ENDOPHTHALMITIS POSTCATARACT SURGERY TREATED WITH INTRAVENOUS AND INTRAMUSCULAR ANTIBIOTICS

Carol Tadrous1, Nadine Cheffi2,3, Rishi B Gupta2

  • 1Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada.

Retinal Cases & Brief Reports
|June 22, 2026
PubMed
Abstract

Insights

Recalcitrant Actinomyces neuii chronic postoperative endophthalmitis (CPE) requires prolonged systemic penicillin and intraocular lens (IOL) explantation. Pharmacokinetic confirmation of intravitreal drug levels supports this successful treatment approach for sustained resolution.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Chronic postoperative endophthalmitis (CPE) can be challenging to treat.
  • Actinomyces neuii is an unusual pathogen causing CPE.
  • Recalcitrant cases necessitate exploring alternative therapeutic strategies.

Purpose of the Study:

  • To report a successful treatment of recalcitrant Actinomyces neuii CPE.
  • To demonstrate the efficacy of prolonged systemic penicillin therapy.
  • To confirm therapeutic intravitreal drug levels via pharmacokinetic analysis.

Main Methods:

  • Retrospective case report.
  • Focused literature review.
  • Intravenous and intramuscular penicillin G administration.
  • Intraocular lens (IOL) explantation.
  • Pharmacokinetic analysis of intravitreal penicillin G levels.

Main Results:

  • A 77-year-old male with recurrent CPE due to A. neuii showed sustained resolution.
  • Treatment involved prolonged systemic penicillin G and IOL explantation.
  • Achieved therapeutic intravitreal penicillin G concentrations (3.5 μg/mL).
  • Visual acuity was limited by prior macular edema complications.

Conclusions:

  • Systemic therapy and interdisciplinary management are crucial for recalcitrant CPE.
  • Prolonged antibiotic courses with confirmed intraocular concentrations and IOL removal are effective.
  • This approach offers sustained resolution for complex endophthalmitis cases.
Keywords:
chronic postoperative endophthalmitisintramuscular benzathine penicillinintraocular lens explantationintravenous penicillin Gintravitreal antibiotics

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