June 2020
Volume 61, Issue 7
ARVO Annual Meeting Abstract  |   June 2020
Postoperative endophthalmitis caused by Cutibacterium (formerly Propionibacterium) acnes
Author Affiliations & Notes
  • Benjamin Fowler
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, United States
  • Darlene Miller
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, United States
  • Xiaohe Yan
    Shenzhen Eye Hospital, China
  • Nicolas Yannuzzi
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, United States
  • Harry W Flynn
    Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, United States
  • Footnotes
    Commercial Relationships   Benjamin Fowler, None; Darlene Miller, None; Xiaohe Yan, None; Nicolas Yannuzzi, None; Harry Flynn, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4413. doi:
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      Benjamin Fowler, Darlene Miller, Xiaohe Yan, Nicolas Yannuzzi, Harry W Flynn; Postoperative endophthalmitis caused by Cutibacterium (formerly Propionibacterium) acnes . Invest. Ophthalmol. Vis. Sci. 2020;61(7):4413.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes).

Methods : Retrospective case series of patients with chronic postoperative endophthalmitis caused by culture-proven C. acnes from December 2010-July 2019 at a University referral center.

Results : Clinical features, treatments and outcomes for the current study are summarized in Table 1 and Figure 1. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5-17 months). Average time from obtaining the specimen to culture positivity was 7.7 days + 4.4 (range 3-15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200, and was 20/80 or better in five out of six patients.

The most common initial treatment was pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (n = 3). The initial treatment for other patients was intravitreal antibiotics alone (n = 2), and PPV with IOL removal and intravitreal antibiotics (n = 1). Two out of six patients (33 %) did not require further treatment after initial therapy, including one patient treated with PPV/partial capsulectomy and intravitreal antibiotics, and another initially treated with PPV/IOL removal and intravitreal antibiotics. Ultimately, three out of six patients (50 %) underwent IOL removal.

The best-corrected visual acuity at last follow-up ranged from 20/15 -3 to 20/70, with an average follow-up time after last treatment of 24 + 26 months (range: 2-57).

Conclusions : Chronic endophthalmitis caused by C. acnes is characterized by slowly progressive intraocular inflammation that is typically not diagnosed until months after cataract surgery. Visual acuity outcomes are generally favorable. Microbiologic cultures may take up to 2 weeks for identification. Many patients diagnosed with endophthalmitis caused by C. acnes eventually require PPV with capsulectomy or IOL removal. Nevertheless, a non-surgical approach still remains a reasonable initial therapy, and visual acuity outcomes are generally favorable even in cases undergoing additional treatments.

This is a 2020 ARVO Annual Meeting abstract.


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