Non–sequential Pseudomonas aeruginosa endophthalmitis following uneventful phacoemulsification caused by same bacterial clone

Abstract

Abstract: : Purpose:To describe two cases of same clone Pseudomonas aeruginosa endophthalmitis following non–sequential uneventful phacoemulsification. Methods: Two patients presented with postoperative endophthalmitis following phacoemulsification (Phaco) in six days apart. In both situations the Phaco surgery were performed on the right eye and were the first of the day. The equipment used was Sovereign with non–disposable tubing. Foldable acrylic intraocular lens was implanted in the bag . Several surgeries were performed among these two cases without postoperative infection. Samples from all internal tubing of the automated cataract surgery equipment were cultured. Results: Both patients started with severe pain, low visual acuity (light perception and hand motion), hyperemia, corneal edema, moderate anterior chamber reaction, miosis and increased intraocular pressure (42 and 45 mmHg), 12 hours after surgery. Twenty– four hours later, the first patient presented with corneal melting, uveal tissue exposure through the main incision and sclera, and no light perception. The second patient also had corneal melting, and white infiltrates on the posterior pole. Despite broad–spectrum antibiotic treatment, one eye was enucleated and the second went to phthisis. Same clone of the Pseudomonas aeruginosa was identified by pulsed field gel electrophoresis in both clinical specimens and from the collection bag. Conclusion: The same equipment was used for other surgeries with no endophthalmitis development. Further investigations must be done to rule out equipment reflux after demonstrating that same Pseudomonas aeruginosa clone was identified as the etiologic agent in both cases of endophthalmitis and was isolated from collection bag.

Keywords: endophthalmitis • Pseudomonas • cataract