Endophthalmitis following vitrectomy for malignant glaucoma: Multidrug-resistant Klebsiella pneumoniae

Abstract

The purpose of this case report is to present a case of acute-onset postoperative endophthalmitis, caused by multidrug-resistant (MDR) Klebsiella pneumonia, following pars plana vitrectomy for malignant glaucoma. A 52-year-old male patient underwent elective phacoemulsification cataract surgery with intraocular lens implantation in the right eye. Two weeks later, the patient presented with a diminution of vision and clinical features suggestive of malignant glaucoma. With no response to conventional treatment, pars plana vitrectomy was done. Acute-onset postoperative endophthalmitis developed, with severe intraocular inflammation, caused by MDR Klebsiella pneumoniae. The isolates demonstrated sensitivity to polymyxins and tigecycline only. Intravitreal colistin (0.1 mg/0.1 mL) was administered. The response was satisfactory and the vision could be salvaged. At 2 months follow-up a visual acuity of 20/50 was recorded. This is a rare case report of acute-onset postoperative endophthalmitis due to MDR Klebsiella following pars plana vitrectomy. With timely intervention, the patient came out of two difficult situations of malignant glaucoma and MDR endophthalmitis with a reasonably good visual recovery.

Keywords

• endophthalmitis
• malignant glaucoma
• polymyxins
• vitrectomy