Endogenous endophthalmitis is a sight-threatening condition caused by microorganisms crossing the blood–ocular barrier and inducing profound intraocular inflammation.
Case report
A 65-year-old female experienced bilateral loss of vision after developing infective endocarditis as a complication of combined Bentall procedure and coronary artery bypass grafting. She was diagnosed with bilateral endogenous endophthalmitis secondary to Serratia marcescens. Despite aggressive treatment with intravitreal injections of antibiotics and steroids, intensive topical and systemic antibiotic therapy, there was permanent loss of sight in both eyes.
Conclusion
The case highlights the importance of early recognition of the symptoms and signs of endogenous endophthalmitis in any patient with systemic infection by all clinicians and the necessity of prompt ophthalmological referral if a useful level of vision is to be preserved.
JacksonTLEykynSJGrahamEM. Endogenous bacterial endophthalmitis: A 17-year prospective series and review of 267 reported cases. Surv Ophthalmol2003; 48: 403–423.
2.
JacobyGAMunoz-PriceLS. The new beta-lactamases. N Engl J Med2005; 352: 380–391.
3.
KoulSPhilipsonAPhilipsonBT. Incidence of endophthalmitis in Sweden. Acta Ophthalmol (Copenh)1989; 67: 499–503.
4.
ShraderSKBandJDLauterCB. The clinical spectrum of endophthalmitis: Incidence, predisposing factors and features influencing outcome. J Infect Dis1990; 162: 115–120.
5.
OkadaAAJohnsonRPLilesWC. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology1994; 101(5): 832–886.
JonesRN. Important and emerging beta-lactamase-mediated resistances in hospital-based pathogens: The Amp C enzymes. Diagn Microbiol Infect Dis1998; 31: 461–466.
10.
SuriRKSelbyDAHawksGH. Serratia marcescens endocarditis. A report of a case involving Cross-Jones mitral valve prosthesis, with a review of the literature. Can Med Assoc J1971; 104: 1013–1014.
OritaHShimanukiTFukasawaM. A clinical study of postoperative infections following open-heart surgery: occurrence and micro-biological findings in 782 cases. Surg Today1992; 22: 207–212.
DonnenfeldEDSchrierAPerryHD. Infectious keratitis with corneal perforation associated with corneal hydrops and contact lens wear in keratoconus. Br J Ophthalmol1996; 80(5): 409–412.
19.
BinderMIChuaJKaiserPK. Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine (Baltimore)2003; 82: 97–105.
20.
KeswaniTAhujaVChangulaniM. Evaluation of outcome of various treatment methods for endogenous endophthalmitis. Indian J Med Sci2006; 60: 454–460.
21.
OkhraviNAdamsonPCarrollN. PCR-based evidence of bacterial involvement in eyes with suspected intraocular infection. Invest Ophthalmol Vis Sci2000; 41: 3474–3479.
22.
LohmannCPLindeHJReischiU. Improved detection of microorganisms by polymerase chain reaction in delayed endophthalmitis after cataract surgery. Ophthalmology2000; 107: 1047–1051.
23.
LivermoreDMBrownDF. Detection of beta-lactamase-mediated resistance. J Antimicrob Chemother2001; 48: 59–64.
24.
CampochiaroPAConwayBP. Aminoglycoside toxicity – a survey of retinal specialists. Implications for ocular use. Arch Ophthalmol1991; 109: 946–950.
25.
CampochiaroPALimJI. Aminoglycoside toxicity in the treatment of endophthalmitis. The Aminoglycoside Toxicity Study Group. Arch Ophthalmol1994; 112: 48–53.
26.
DoftBHBarzaM. Ceftazidime or amikacin: Choice of intravitreal antimicrobials in the treatment of postoperative endophthalmitis. Arch Ophthalmol1994; 112: 17–17.
27.
SakamotoHSakamotoMHataY. Aqueous and vitreous penetration of levofloxacin after topical and/or oral administration. Eur J Ophthalmol2007; 17: 372–372.
28.
EquiRAGreenWR. Endogenous Serratia marcescens endophthalmitis with dark hypopyon: Case report and review. Surv Ophthalmol2001; 46: 259–259.
29.
The Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol1995; 113: 1479–1479.
