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Propionibacterium endophthalmitis following Molteno tube repositioning
1University of Pittsburgh Medical Center, Pennsylvania, U.S.A.
Purpose:
We describe an aphakic patient who developed recurrent Propionibacterium acnes endophthalmitis after Molteno tube revision.
Patient And Method:
The patient presented with a red painful right eye, decreased vision, and a hypopyon. A moderate anterior chamber reaction and mild vitritis were present. Two weeks earlier, the patient had undergone Molteno tube repositioning. A diagnosis of P. acnes endophthalmitis was made after positive culture of anterior chamber needle aspirate.
Results:
Initially the patient was treated with repeated intraocular vancomycin injections, to which the eye "responded poorly." Temporary clearance of the infection was achieved after placement of the tube in the subconjunctival space. The patient required explantation of the implant to achieve complete resolution of the infection.
Conclusion:
Tube reinsertion into the anterior chamber resulted in recurrence of the infection. The evaluation of alternative therapies of aqueous tube shunt-related endophthalmitis would require a large case-controlled series of patients.
Insights
Recurrent Propionibacterium acnes endophthalmitis occurred in an aphakic patient after Molteno tube revision. Complete resolution required explantation of the glaucoma drainage device.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Glaucoma drainage devices are used to manage intraocular pressure.
- Molteno tubes are a type of glaucoma drainage device.
- Endophthalmitis is a serious intraocular infection.
Observation:
- An aphakic patient developed recurrent Propionibacterium acnes endophthalmitis after Molteno tube revision.
- Symptoms included a red, painful eye, decreased vision, and hypopyon.
- Diagnosis was confirmed by positive culture of anterior chamber aspirate.
Findings:
- Initial treatment with intraocular vancomycin was poorly effective.
- Subconjunctival placement of the tube provided temporary clearance.
- Complete resolution was achieved only after explantation of the Molteno tube.
Implications:
- Reinsertion of the tube into the anterior chamber led to infection recurrence.
- This case highlights the challenges in managing tube shunt-related endophthalmitis.
- Further research with large case-controlled studies is needed to evaluate alternative therapies.