Delayed-onset endophthalmitis associated with Achromobacter species developed in acute form several months after cataract surgery: Three case reports

Abstract

Background: Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis. Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare. Intraocular lens (IOL) removal is commonly recommended to treat Achromobacter species endophthalmitis, which is based on previous studies. Here, we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.

Case summary: Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier. They had undergone cataract surgery 5-18 mo prior. Best-corrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception. They showed conjunctival injection, inflammation in the anterior chamber (cell reaction 4+) and hypopyon formation. The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy, anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin. Before fluid infusion, a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreous specimen culture. After surgery, the vitreous opacity decreased gradually and there was little retinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50 and 20/40.

Conclusion: Delayed onset postoperative endophthalmitis caused by Achromobacter species can appear in an acute form. All patients responded well to early vitrectomy and administration of empirical antibiotics including ceftazidime. There was no need for IOL removal during surgery.

Keywords: Achromobacter species; Case report; Chronic endophthalmitis; Postoperative endophthalmitis.

Figure 1

Anterior segment photograph and ultrasonogram at the initial disease presentation in a patient with a history of cataract surgery from 18 mo prior. A: Conjunctival injection and hypopyon formation in the anterior chamber; B: Heterogenous vitreous opacity is evident in the B-scan ultrasonogram.