Burkholderia cepacia, a cause of post pars plana vitrectomy silicone oil related endophthalmitis: clinico-pathological presentation and outcome of management

Abstract

Aim: To report the long-term outcome of the management of a series of culture proven post pars plana vitrectomy endophthalmitis in which the infective agent was in the silicone oil used as an endotamponade. The isolates were Burkholderia cepacia and Pseudomonas aeruginosa.

Method: A retrospective interventional reporting of a series consisting of a cluster of five cases.

Cases: Five consecutive patients received the same batch of 5000-centistoke silicone oil as endotamponade at the conclusion of vitreoretinal surgery and presented with features of acute intraocular inflammation, which was due to an infective cause. The infective organism isolated from the mixture of silicone oil and fluid was B. cepacia in three out of the initial cluster of four eyes and P. aeruginosa in the fifth eye.

Outcome of management: The initial 4 eyes evolved into eyes with poor vision (hand motion, perception of light and no perception of light), advanced proliferative vitreoretinopathy, hypotony, phthisis bulbi and cornea opacity. The poor visual outcome was deemed to be consequent to delay in removal of the silicone oil, despite use of intravitreal, systemic and topical antibiotics. The fifth case, because of the heightened index of suspicion gained from the preceding four cases, had a prompt removal of the silicone oil, vitreal lavage with antibiotics, and intravitreal injection of antibiotics and steroid. He regained a 6/9 vision.

Conclusion: Gram-negative bacilli can colonize silicone oil resulting in post pars plana vitrectomy endophthalmitis. The index of suspicion for this should be high and can be managed successfully with prompt removal of the silicone oil, microbial sensitive antibiotic lavage of the vitreous cavity, followed by a repeat tamponade.

Keywords: Burkholderia cepacia; Endophthalmitis; Pseudomonas aeruginosa; Silicone oil; Vitrectomy.

Fig. 1

Case 1 B scan ultrasonography of the right eye done on the 11th of August before silicone oil removal, showing high echogenicity in the anterior vitreous cavity

Fig. 2

a, b. Shows the right eye with advance PVR process under the silicone oil and normal appearing left eye

Fig. 3

Case 3 treatment outcome results in a phthisical globe

Fig. 4

a–d Case 5 a an inferior retina detachment. b Laser induced chorioretina scar around the treated retina break. c Post operative attached retina appearance of the operated left eye. d Right eye