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S. N. Martin, N. J. Sund, G. A. Williams; Good Visual Outcome After Acute Postoperative Morganella Morganii Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):957.
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Postoperative bacterial endophthalmitis is an uncommon but potentially devastating complication of intraocular surgery. Few cases of Morganella morganii endophthalmitis have been reported in the literature, and the majority has had poor visual outcomes. We describe the clinical course and visual outcome of a patient who presented with acute onset postoperative endophthalmitis due to Morganella morganii, in whom early and aggressive treatment resulted in good visual recovery.
A 78 year-old Caucasian man presented with symptoms and signs of acute onset endophthalmitis one month after having left eye combined trabeculectomy and phacoemulsification cataract extraction with intraocular lens implantation. We performed a 3-port 25 gauge pars plana vitrectomy and vitreous biopsy with intravitreal injection of vancomycin (1 mg in 0.1mL) and ceftazidime (2.25 mg in 0.1mL) the day of presentation. Gram stain, aerobic, and anaerobic cultures were performed of the vitreous aspirate. The patient was followed for routine post-operative care.
On initial presentation, the patient’s vision in his left eye was light perception only. Slit lamp examination showed 4+ anterior chamber cells, a 2 mm hypopyon, and no view of the fundus. The bleb was not leaking on presentation. B-scan ultrasonography showed dense vitreous opacities. The decision was made to perform an emergent pars plana vitrectomy with vitreous biopsy and injection of intravitreal antibiotics, which was uncomplicated. Vitreous cultures were positive for Morganella morganii, sensitive to ceftazidime. The patient had an uneventful immediate post-operative course and three months post-operatively, the patient’s best-corrected visual acuity is 20/50 with minimal vitreous debris.
Morganella morganii is a rare cause of acute postoperative endophthalmitis, usually associated with a poor outcome. However, with early and aggressive intervention, the patient may have a good clinical outcome and visual recovery.
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