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WJ Thomas, EL Thomas, RE Roeske, DS Boyer, M Kroll, RL Novack; Acute and Chronic Endophthalmitis Caused by Alcaligenes Xylosoxidans: Hisopathologic findings . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4450.
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Purpose: To present two cases of consecutive, acute and chronic endophthalmitis caused by A. Xylosoxidans. Subsequent chronic granulomatous uveitis and secondary peripheral anterior synechiae formation are poorly responsive to antibiotic sterilization unless the intraocular lens (IOL) and the complete lens capsule are removed. Methods:Two consecutive patients developed acute endophthalmitis following cataract extraction and IOL implantation. Earliest culture was positive in both, with resistance to amikacin and vancomycin and sensitive to ceftazadime. Multiple ceftazadime injections produced incomplete resolution of the infections and inflammation. Removal of the IOL and capsule was eventually required to obtain resolution. Review of the literature shows one case of acute and several cases of delayed endophthalmitis caused by Alcaligenes Xylosoxidans. Histopathological evaluation of one of the removed IOLs and capsule was performed. Results:These 2 cases of A. Xylosoxidans endophthalmitis required surgical removal of the IOL and capsule for elimination of chronic inflammation. Histopathologic evaluation of the removed IOL and capsule demonstrated a multinucleated giant cell response presumably due to bacterial proteins and by-products present on the IOL and sequesterred within the capsule that were unresponsive to appropriate antibiotic therapy. Chronic angle closure glaucoma developed in one eye due to the PAS formation. Conclusion:Acute endophthalmitis caused by A. Xylosoxidans is extremely rare. We present two cases after cataract extraction and IOL implantation. Our data suggest that despite multiple antibiotic injections, surgical removal of the IOL and capsule is necessary to eliminate a chronic uveitic pattern. Based on the histopathologic evidence, early removal of the IOL and capsule appear to be warranted in cases of A. Xylosoxidans endophthalmitis.
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