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E. Huang, T. Chu, E. Chaum, S. Mukai; Vancomycin–resistant Enterococcal Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2775.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:Enterococcal endophthalmitis is usually quite severe. Enterococci can develop relative and absolute resistance to antibiotics commonly used to treat gram–positive infections including endophthalmitis. We present two cases of acute endophthalmitis from vancomycin–resistant enterococcus. Methods: Retrospective review of two cases of enterococcus–mediated endophthalmitis after cataract surgery. Case 1: Diabetic man underwent phacoemulsification complicated by nuclear loss then had pars plana vitrectomy (PPV) and lensectomy on the same day. 1 week later he developed 20% hypopyon treated by PPV and intravitreal vancomycin, amikacin and dexamethasone. The tap grew enterococcus sensitive to vancomycin. The eye worsened over 2 days with 80% hypopyon treated by anterior chamber (AC) washout and repeat intravitreal vancomycin. 80% hypopyon redeveloped over 2 days and he underwent PPV, AC washout, and reinjection with vancomycin, amikacin and dexamethasone. A preretinal membrane was noted but not peeled. The specimen again grew enterococcus sensitive to vancomycin. 80% hypopyon redeveloped 2 days later and PPV, vitreous and preretinal membrane removal, and intravitreal vancomycin were done, and he was started on IV vancomycin. PPV specimen revealed abundant enterococcus sensitive to vancomycin (MIC <=2). The infection was finally controlled. Case 2: A woman developed acute endophthalmitis after uncomplicated cataract surgery and was treated with PPV and intravitreal vancomycin and amikacin. There was no improvement over 2 days, and the specimen grew enterococcus resistant to vancomycin and amikacin. The eye received intravitreal chloramphenicol 1 mg with resolution of the infection. Results: In both cases, the eye was saved. The visual outcome was poor with no light perception in Case 1. The second case was lost to follow–up. Conclusions: Enterococcal endophthalmitis is difficult to manage due to aggressiveness of the infection and antibiotic resistance. In cases of antibiotic resistance, multiple procedures requiring more complete removal of membranes that could harbor organisms or creative use of antibiotics may be necessary to preserve the eye.
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