Conservative approach in the management of chronic postoperative Propionibacterium acnes endophthalmitis: A case report with review of literature

Abstract

Chronic endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens (IOL) implantation secondary to slow-growing organisms such as Propionibacterium acnes. A 68-year-old male presented with pain and diminution of vision 4 months after uneventful phacoemulsification with IOL implantation. Slit-lamp examination showed trace hypopyon, conjunctival congestion with anterior chamber cells and flare, vitreous haze, and posterior capsular plaque-like deposits suggestive of probable P. acnes endophthalmitis. Intravitreal antibiotics did not provide any relief. The diagnosis was confirmed using PCR on the aqueous aspirate. Intracameral and in-the-bag injection of antibiotic caused the resolution of infection and improvement in visual acuity. This report thus highlights that in-the-bag antibiotics can help conservatively manage this condition without the need for an invasive procedure like vitrectomy and IOL explantation.

Keywords

• chronic postoperative endophthalmitis
• in-the-bag antibiotic
• polymerase chain reaction
• propionibacterium acnes