Refractory Staphylococcus hominis Endophthalmitis With Corneal Involvement Following Cataract Surgery: A Case Report

Area of Science:

• Ophthalmology
• Infectious Diseases

Background:

• Postoperative endophthalmitis can occur after cataract surgery.
• Delayed-onset and refractory cases pose significant management challenges.

Purpose of the Study:

• To report an unusual case of delayed-onset, refractory endophthalmitis caused by Staphylococcus hominis.
• To highlight the role of tectonic keratoplasty in managing such complex cases.

Main Methods:

• A case study of a 74-year-old diabetic patient who developed endophthalmitis post-cataract surgery.
• Involved multiple interventions including vitreous taps, pars plana vitrectomies, intravitreal antibiotics, and corneal biopsies.
• Diagnosis of Staphylococcus hominis infection was confirmed via corneal sampling.
• Treatment included systemic linezolid, topical vancomycin, and ultimately, tectonic keratoplasty.

Main Results:

• The patient presented with delayed-onset, refractory endophthalmitis with recurrent hypopyon and corneal infiltration.
• Initial cultures were negative; Staphylococcus hominis was identified from corneal biopsies.
• Despite maximal medical therapy, tectonic keratoplasty was necessary for definitive management.
• Successful control of infection and resolution of inflammation were achieved post-keratoplasty.

Conclusions:

• Staphylococcus hominis should be considered in persistent postoperative endophthalmitis, especially in diabetic patients.
• Tectonic keratoplasty may be essential for source control when medical management fails.
• This case underscores the importance of considering less common pathogens and advanced surgical interventions.