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Case Report: Delayed-onset and recurrent infectious endophthalmitis after intravitreal dexamethasone implant
Xinyue Yang1, Mengfan Li1, Yiwei Zhu1
1Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China.
Purpose:
To report a rare case of delayed-onset infectious endophthalmitis occurring 33 days after an intravitreal dexamethasone implant (Ozurdex®), with recurrence 20 days after complete pars plana vitrectomy and implant removal.
Methods:
Case report with clinical findings, diagnostic workup, management, and literature review.
Results:
A 51-year-old male with recurrent anterior uveitis received a dexamethasone implant for refractory cystoid macular edema. Thirty-three days post-injection, he developed acute hypopyon and severe vitritis. Emergent 25-gauge pars plana vitrectomy with implant removal was performed. Aqueous humor metagenomic next-generation sequencing (mNGS) confirmed Staphylococcus epidermidis (24,904 reads; 99.96% relative abundance), with no resistance genes detected. Postoperatively, inflammation initially resolved; however, hypopyon recurred 20 days after vitrectomy. A 6-day course of intravenous vancomycin achieved complete resolution. At final follow-up, best-corrected visual acuity improved to 20/33, with no further recurrence.
Conclusion:
Endophthalmitis following corticosteroid implants may present with delayed-onset and can recur even after complete surgical removal. Systemic antimicrobial therapy may play a crucial role in eradicating residual infection in such challenging cases.
