Korean J Ophthalmol.  2011 Aug;25(4):285-288. 10.3341/kjo.2011.25.4.285.

Late-Onset Citrobacter koseri Endophthalmitis with Suture Exposure after Secondary Intraocular Lens Implantation

• Kang HM
• Chung EJ

• KMID: 1018420
• DOI: http://doi.org/10.3341/kjo.2011.25.4.285

Abstract

A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.

Keyword

Citrobacter koseri; Endophthalmitis; Secondary intraocular lens implantation

MeSH Terms

Anti-Bacterial Agents/administration & dosage
Cataract Extraction/adverse effects
Citrobacter koseri/*isolation & purification
Diagnosis, Differential
Endophthalmitis/diagnosis/*microbiology/therapy
Enterobacteriaceae Infections/diagnosis/*microbiology/therapy
Eye Infections, Bacterial/diagnosis/*microbiology/therapy
Follow-Up Studies
Humans
Intravitreal Injections
Lens Implantation, Intraocular/*adverse effects
Male
Microscopy, Acoustic
Middle Aged
Surgical Wound Infection/diagnosis/*microbiology/therapy
Sutures/adverse effects/microbiology
Visual Acuity
Vitrectomy
Vitreous Body/*microbiology

Figure

• 

  Fig. 1 Slit lamp photography of the right eye at initial presentation. Severe conjunctival injection and exposed suture material at 6 o'clock direction were observed. Also, an edematous cornea with 3.0-mm-height hypopyon was observed.

• 

  Fig. 2 B-scan ultrasonography of the right eye at initial presentation. Significant vitreous opacity was observed.

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  Fig. 3 Twelve weeks after vitrectomy, best corrected visual acuity was improved to 0.7 (refractive errors +12.0 sph -1.50 cyl Ax90), according to a Snellen chart examination. (A) Cornea and anterior chamber were both clear. (B) According to a fundus examination, a relatively normal optic disc and retinal vasculature were observed.

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