Streptococcus agalactiae Endophthalmitis in Boston Keratoprosthesis in a Patient with Steven-Johnson Syndrome

Abstract

A 25-year-old Syrian male with a previous episode of Stevens-Johnson syndrome with bilateral corneal cicatrization previously underwent surgery for Type 1 Boston Keratoprosthesis (K-Pro). Sixteen months after the K-Pro surgery, the patient presented with decreased vision to hand motion and microbial keratitis of the graft around the K-Pro with purulent discharge. Corneal scrapings were nonrevealing. B-scan in 3 days showed increased debris in the vitreous cavity and thickened retinochoroidal layer. Intravitreal tap and injections of vancomycin and ceftazidime were performed. The vitreous culture revealed β-hemolytic Streptococcus agalactiae; fungal cultures were negative. Repeat B-scan 3 days later demonstrated decreased vitreous opacity, and the patient felt more comfortable and was without pain. His visual acuity improved to 20/70, ocular findings have been stable for 9 months, and the patient continues to be monitored.

Keywords: Boston Keratoprosthesis; Endophthalmitis; Steven–Johnson Syndrome; Streptococcus agalactiae.

Figure 1

Slit-lamp photograph of right eye of the patient with Stevens–Johnson syndrome showing corneal scarring, neovascularization, and symblepharon. Visual acuity is hand motion (a). Left eye of the same patient before Boston keratoprosthesis surgery shows corneal haze, neovascularization, and cystic stromal changes (b)

Figure 2

Slit-lamp photograph of left eye of the patient with Steven–Johnson syndrome with Boston keratoprosthesis that developed acute bacterial endophthalmitis with blepharitis, conjunctival chemosis, hyperemia, and discharge. Visual acuity dropped to 20/300 (a). The same eye after the treatment with fortified topical and intravitreal antibiotics shows improved blepharitis, no hyperemia and ocular surface free of purulent discharge. Visual acuity improved to 20/70 (b)