Endophthalmitis caused by Achromobacter xylosoxidans after cataract surgery

Abstract

Purpose: To report Achromobacter xylosoxidans as a cause of both acute-onset and delayed-onset postoperative endophthalmitis after cataract surgery.

Methods: A noncomparative consecutive case series of patients with culture-proven A. xylosoxidans endophthalmitis between 1970 and 2012. Cataract surgery and intraocular lens placement were performed in all patients before endophthalmitis. Positive cultures were obtained from the vitreous, capsular bag, and/or the removed intraocular lens.

Results: The clinical diagnosis was confirmed in four patients with positive cultures. Two patients with endophthalmitis had a preliminary culture report of Pseudomonas species. In addition to receiving intravitreal antibiotics, all patients underwent capsulectomy and intraocular lens removal at the time of pars plana vitrectomy. Visual acuity at last follow-up was 20/40 or better in 2 (50%) of the 4 patients, but the remaining 2 patients were 20/200 or worse.

Conclusion: A. xylosoxidans may be a cause of acute, recurrent, and delayed-onset postoperative endophthalmitis after cataract surgery. Complete capsulectomy and intraocular lens removal can be considered in recurrent and recalcitrant patients.

Figure 1

Anterior segment photograph of Case 4 presenting an intact corneal wound, ciliary hyperemia, moderate anterior chamber cellular reaction with a 1 mm hypopyon, with segmental posterior capsule opacity and a well placed posterior chamber intraocular lens.

Figure 2

(A) Histopathologic analysis demonstrating gram-negative rods on inner aspect of anterior capsule and (B) on inner aspect of posterior capsule.