Staphylococcus epidermidis endophthalmitis following intraocular lens implantation

A 90-year-old man developed a hypopyon following cataract extraction with intraocular lens implantation. The hypopyon cleared with topical corticosteroid therapy but recurred whenever the corticosteroid therapy was reduced. At surgery for the removal of the intraocular lens an opaque anterior vitreous membrane was excised. Cultures of the anterior vitreous grew Staphylococcus epidermidis. The diagnosis was further confirmed by the histology of the anterior vitreous membrane, which showed Gram-positive cocci in the macrophages and polymorphonuclear leucocytes. This case shows that corticosteroids may completely mask an endophthalmitis from an organism of low virulence such as Staphylococcus epidermidis. Endophthalmitis from an organism of low virulence should be considered in any case of persistent postoperative inflammation.