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. 1994 Feb;78(2):115–119. doi: 10.1136/bjo.78.2.115

Aggressive management of an epidemic of chronic pseudophakic endophthalmitis: results and literature survey.

N K Rogers 1, P D Fox 1, B A Noble 1, K Kerr 1, T Inglis 1
PMCID: PMC504712  PMID: 8123618

Abstract

Six cases of chronic endophthalmitis following extracapsular cataract extraction and lens implantation are reviewed. All were referred for tertiary management by one surgeon over a period of just over 2 years. In two of the cases coagulase negative staphylococci were isolated and in three Propionibacterium spp were retrieved. In the remaining case a mixed growth of coagulase negative staphylococci and Propionibacterium acnes was cultured. The surgical management, microbiological results, and eventual visual outcome are discussed. To our knowledge, this is the first documented outbreak of chronic pseudophakic endophthalmitis with commensal organisms from a single centre.

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Selected References

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  1. ALLEN H. F., MANGIARACINE A. B. BACTERIAL ENDOPHTHALMITIS AFTER CATARACT EXTRACTION. A STUDY OF 22 INFECTIONS IN 20,000 OPERATIONS. Arch Ophthalmol. 1964 Oct;72:454–462. doi: 10.1001/archopht.1964.00970020454003. [DOI] [PubMed] [Google Scholar]
  2. Brook I. Pathogenicity of Propionibacterium acnes in mixed infections with facultative bacteria. J Med Microbiol. 1991 May;34(5):249–252. doi: 10.1099/00222615-34-5-249. [DOI] [PubMed] [Google Scholar]
  3. Chien A. M., Raber I. M., Fischer D. H., Eagle R. C., Jr, Naidoff M. A. Propionibacterium acnes endophthalmitis after intracapsular cataract extraction. Ophthalmology. 1992 Apr;99(4):487–490. doi: 10.1016/s0161-6420(92)31923-2. [DOI] [PubMed] [Google Scholar]
  4. Cummins C. S., Johnson J. L. Corynebacterium parvum: a synonym for Propionibacterium acnes? J Gen Microbiol. 1974 Feb;80(2):433–442. doi: 10.1099/00221287-80-2-433. [DOI] [PubMed] [Google Scholar]
  5. Cusumano A., Busin M., Spitznas M. Is chronic intraocular inflammation after lens implantation of bacterial origin? Ophthalmology. 1991 Nov;98(11):1703–1710. doi: 10.1016/s0161-6420(91)32065-7. [DOI] [PubMed] [Google Scholar]
  6. Davis J. L., Koidou-Tsiligianni A., Pflugfelder S. C., Miller D., Flynn H. W., Jr, Forster R. K. Coagulase-negative staphylococcal endophthalmitis. Increase in antimicrobial resistance. Ophthalmology. 1988 Oct;95(10):1404–1410. doi: 10.1016/s0161-6420(88)32990-8. [DOI] [PubMed] [Google Scholar]
  7. Ficker L., Meredith T. A., Wilson L. A., Kaplan H. J., Kozarsky A. M. Chronic bacterial endophthalmitis. Am J Ophthalmol. 1987 Jun 15;103(6):745–748. doi: 10.1016/s0002-9394(14)74386-7. [DOI] [PubMed] [Google Scholar]
  8. Fisch A., Salvanet A., Prazuck T., Forestier F., Gerbaud L., Coscas G., Lafaix C. Epidemiology of infective endophthalmitis in France. The French Collaborative Study Group on Endophthalmitis. Lancet. 1991 Nov 30;338(8779):1373–1376. [PubMed] [Google Scholar]
  9. Fox G. M., Joondeph B. C., Flynn H. W., Jr, Pflugfelder S. C., Roussel T. J. Delayed-onset pseudophakic endophthalmitis. Am J Ophthalmol. 1991 Feb 15;111(2):163–173. doi: 10.1016/s0002-9394(14)72254-8. [DOI] [PubMed] [Google Scholar]
  10. Friberg T. R., Kuzma P. M. Propionibacterium acnes endophthalmitis two years after extracapsular cataract extraction. Am J Ophthalmol. 1990 May 15;109(5):609–610. doi: 10.1016/s0002-9394(14)70703-2. [DOI] [PubMed] [Google Scholar]
  11. Garner A. Complications of prosthetic intraocular lens implantation: a histopathological study. Br J Ophthalmol. 1989 Dec;73(12):940–945. doi: 10.1136/bjo.73.12.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Gerding D. N., Poley B. J., Hall W. H., LeWin D. P., Clark M. D. Treatment of Pseudomonas endophthalmitis associated with prosthetic intraocular lens implantation. Am J Ophthalmol. 1979 Nov;88(5):902–908. doi: 10.1016/0002-9394(79)90569-5. [DOI] [PubMed] [Google Scholar]
  13. Griffiths P. G., Elliot T. S., McTaggart L. Adherence of Staphylococcus epidermidis to intraocular lenses. Br J Ophthalmol. 1989 Jun;73(6):402–406. doi: 10.1136/bjo.73.6.402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Haimann M. H., Weiss H., Miller J. A. Delayed-onset pseudophakic endophthalmitis. Am J Ophthalmol. 1991 May 15;111(5):656–657. doi: 10.1016/s0002-9394(14)73722-5. [DOI] [PubMed] [Google Scholar]
  15. Jansen B., Hartmann C., Schumacher-Perdreau F., Peters G. Late onset endophthalmitis associated with intraocular lens: a case of molecularly proved S. epidermidis aetiology. Br J Ophthalmol. 1991 Jul;75(7):440–441. doi: 10.1136/bjo.75.7.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Javitt J. C., Vitale S., Canner J. K., Street D. A., Krakauer H., McBean A. M., Sommer A. National outcomes of cataract extraction. Endophthalmitis following inpatient surgery. Arch Ophthalmol. 1991 Aug;109(8):1085–1089. doi: 10.1001/archopht.1991.01080080045025. [DOI] [PubMed] [Google Scholar]
  17. Joondeph B. C., Flynn H. W., Jr, Miller D., Joondeph H. C. A new culture method for infectious endophthalmitis. Arch Ophthalmol. 1989 Sep;107(9):1334–1337. doi: 10.1001/archopht.1989.01070020404044. [DOI] [PubMed] [Google Scholar]
  18. Manners R. M., Canning C. R. Posterior lens capsule abscess due to Propionibacterium acnes and Staphylococcus epidermidis following extracapsular cataract extraction. Br J Ophthalmol. 1991 Dec;75(12):710–712. doi: 10.1136/bjo.75.12.710. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Mao L. K., Flynn H. W., Jr, Miller D., Pflugfelder S. C. Endophthalmitis caused by streptococcal species. Arch Ophthalmol. 1992 Jun;110(6):798–801. doi: 10.1001/archopht.1992.01080180070030. [DOI] [PubMed] [Google Scholar]
  20. Meisler D. M., Mandelbaum S. Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology. 1989 Jan;96(1):54–61. doi: 10.1016/s0161-6420(89)32939-3. [DOI] [PubMed] [Google Scholar]
  21. Meisler D. M., Palestine A. G., Vastine D. W., Demartini D. R., Murphy B. F., Reinhart W. J., Zakov Z. N., McMahon J. T., Cliffel T. P. Chronic Propionibacterium endophthalmitis after extracapsular cataract extraction and intraocular lens implantation. Am J Ophthalmol. 1986 Dec 15;102(6):733–739. doi: 10.1016/0002-9394(86)90401-0. [DOI] [PubMed] [Google Scholar]
  22. Meisler D. M., Zakov Z. N., Bruner W. E., Hall G. S., McMahon J. T., Zachary A. A., Barna B. P. Endophthalmitis associated with sequestered intraocular Propionibacterium acnes. Am J Ophthalmol. 1987 Oct 15;104(4):428–429. doi: 10.1016/0002-9394(87)90240-6. [DOI] [PubMed] [Google Scholar]
  23. Menikoff J. A., Speaker M. G., Marmor M., Raskin E. M. A case-control study of risk factors for postoperative endophthalmitis. Ophthalmology. 1991 Dec;98(12):1761–1768. doi: 10.1016/s0161-6420(91)32053-0. [DOI] [PubMed] [Google Scholar]
  24. O'Day D. M., Jones D. B., Patrinely J., Elliott J. H. Staphylococcus epidermidis endophthalmitis. Visual outcome following noninvasive therapy. Ophthalmology. 1982 Apr;89(4):354–360. [PubMed] [Google Scholar]
  25. Oum B. S., D'Amico D. J., Wong K. W. Intravitreal antibiotic therapy with vancomycin and aminoglycoside. An experimental study of combination and repetitive injections. Arch Ophthalmol. 1989 Jul;107(7):1055–1060. doi: 10.1001/archopht.1989.01070020117043. [DOI] [PubMed] [Google Scholar]
  26. Pettit T. H., Olson R. J., Foos R. Y., Martin W. J. Fungal endophthalmitis following intraocular lens implantation. A surgical epidemic. Arch Ophthalmol. 1980 Jun;98(6):1025–1039. doi: 10.1001/archopht.1980.01020031015002. [DOI] [PubMed] [Google Scholar]
  27. Rothman R. J., Friberg T. J., Kavenchak L. M., Kowalski R. P. Diagnosis of Propionbacterium acnes endophthalmitis. Retina. 1990;10(4):319–321. [PubMed] [Google Scholar]
  28. Roussel T. J., Culbertson W. W., Jaffe N. S. Chronic postoperative endophthalmitis associated with Propionibacterium acnes. Arch Ophthalmol. 1987 Sep;105(9):1199–1201. doi: 10.1001/archopht.1987.01060090057026. [DOI] [PubMed] [Google Scholar]
  29. Semel J., Nobe J., Bowe B., Finegold S., Smith R. E. Propionibacterium acnes isolated from explanted intraocular lens in pseudophakic bullous keratopathy. Cornea. 1989 Dec;8(4):259–262. [PubMed] [Google Scholar]
  30. Sherwood D. R., Rich W. J., Jacob J. S., Hart R. J., Fairchild Y. L. Bacterial contamination of intraocular and extraocular fluids during extracapsular cataract extraction. Eye (Lond) 1989;3(Pt 3):308–312. doi: 10.1038/eye.1989.44. [DOI] [PubMed] [Google Scholar]
  31. Shrader S. K., Band J. D., Lauter C. B., Murphy P. The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome. J Infect Dis. 1990 Jul;162(1):115–120. doi: 10.1093/infdis/162.1.115. [DOI] [PubMed] [Google Scholar]
  32. Smith R. E. Inflammation after cataract surgery. Am J Ophthalmol. 1986 Dec 15;102(6):788–790. doi: 10.1016/0002-9394(86)90409-5. [DOI] [PubMed] [Google Scholar]
  33. Stern G. A., Engel H. M., Driebe W. T., Jr Recurrent postoperative endophthalmitis. Cornea. 1990 Apr;9(2):102–107. [PubMed] [Google Scholar]
  34. Stern G. A., Engel H. M., Driebe W. T., Jr The treatment of postoperative endophthalmitis. Results of differing approaches to treatment. Ophthalmology. 1989 Jan;96(1):62–67. doi: 10.1016/s0161-6420(89)32938-1. [DOI] [PubMed] [Google Scholar]
  35. Vafidis G. C., Marsh R. J., Stacey A. R. Bacterial contamination of intraocular lens surgery. Br J Ophthalmol. 1984 Aug;68(8):520–523. doi: 10.1136/bjo.68.8.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Vafidis G. Propionibacterium acnes endophthalmitis. Br J Ophthalmol. 1991 Dec;75(12):706–706. doi: 10.1136/bjo.75.12.706. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Walker J., Dangel M. E., Makley T. A., Opremcak E. M. Postoperative Propionibacterium granulosum endophthalmitis. Arch Ophthalmol. 1990 Aug;108(8):1073–1074. doi: 10.1001/archopht.1990.01070100029015. [DOI] [PubMed] [Google Scholar]
  38. Wang W. L., Everett E. D., Johnson M., Dean E. Susceptibility of Propionibacterium acnes to seventeen antibiotics. Antimicrob Agents Chemother. 1977 Jan;11(1):171–173. doi: 10.1128/aac.11.1.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Weber D. J., Hoffman K. L., Thoft R. A., Baker A. S. Endophthalmitis following intraocular lens implantation: report of 30 cases and review of the literature. Rev Infect Dis. 1986 Jan-Feb;8(1):12–20. doi: 10.1093/clinids/8.1.12. [DOI] [PubMed] [Google Scholar]
  40. Webster G. F., Leyden J. J., Musson R. A., Douglas S. D. Susceptibility of Propionibacterium acnes to killing and degradation by human neutrophils and monocytes in vitro. Infect Immun. 1985 Jul;49(1):116–121. doi: 10.1128/iai.49.1.116-121.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Whitcup S. M., Belfort R., Jr, de Smet M. D., Palestine A. G., Nussenblatt R. B., Chan C. C. Immunohistochemistry of the inflammatory response in Propionibacterium acnes endophthalmitis. Arch Ophthalmol. 1991 Jul;109(7):978–979. doi: 10.1001/archopht.1991.01080070090041. [DOI] [PubMed] [Google Scholar]
  42. Yang C. M., Cousins S. W. Fate of the fellow eye after Propionibacterium acnes endophthalmitis. Am J Ophthalmol. 1991 Jul 15;112(1):99–100. doi: 10.1016/s0002-9394(14)76227-0. [DOI] [PubMed] [Google Scholar]
  43. Zambrano W., Flynn H. W., Jr, Pflugfelder S. C., Roussel T. J., Culbertson W. W., Holland S., Miller D. Management options for Propionibacterium acnes endophthalmitis. Ophthalmology. 1989 Jul;96(7):1100–1105. doi: 10.1016/s0161-6420(89)32768-0. [DOI] [PubMed] [Google Scholar]

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