J Korean Ophthalmol Soc.  2016 Oct;57(10):1651-1655. 10.3341/jkos.2016.57.10.1651.

A Case of Raoultella planticola Endophthalmitis after Cataract Surgery

• Ahn J
• Huh HD
• Kong M
• Chung IY
• Park JM
• Han YS

• KMID: 2355424
• DOI: http://doi.org/10.3341/jkos.2016.57.10.1651

Abstract

PURPOSE
To report the first case of the Raoultella planticola endophthalmitis after the phacoemulsification and posterior chamber multi-focused intraocular lens (IOL) implantation.
CASE SUMMARY
A healthy 49-year-old male visited our clinic with a sudden visual disturbance and ocular pain 2 days after phacoemulsification and multi-focused IOL implantation in his right eye. On initial ophthalmic examination, severe corneal edema and hypopyon were observed. The retina could not be visualized due to vitreous opacity and anterior chamber inflammation. Therefore, the patient immediately underwent pars plana vitrectomy. Vancomycin hydrogen chloride (HCl) 0.3 mg/0.1 mL was injected into the anterior part and vancomycin HCl 1.0 mg/0.1 mL and ceftazidime 2.0 mg/0.1 mL were injected into the intravitreal part. The culture test of aqueous humor and vitreous body fluid revealed Raoultella planticola, thus, systemic antibiotic (ceftazidime) and antibiotic eye drops (vancomycin and ceftazidime) were administered. After 4 months of follow-up, best-corrected visual acuity improved to 20/20 in the affected eye after surgery.
CONCLUSIONS
In the present case, we found that endophthalmitis due to Raoultella planticola can be successfully treated. We suggest that atypical bacteria should be considered in the differential diagnosis of endophthalmitis after cataract surgery.

Keyword

Cataract surgery; Endophthalmitis; Raoultella planticola

MeSH Terms

Anterior Chamber
Aqueous Humor
Bacteria
Cataract*
Ceftazidime
Corneal Edema
Diagnosis, Differential
Endophthalmitis*
Follow-Up Studies
Humans
Hydrochloric Acid
Inflammation
Lenses, Intraocular
Male
Middle Aged
Ophthalmic Solutions
Phacoemulsification
Retina
Vancomycin
Visual Acuity
Vitrectomy
Vitreous Body
Ceftazidime
Hydrochloric Acid
Ophthalmic Solutions
Vancomycin

Figure

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  Figure 1. Anterior segment photograph and ultrasonogram at the the initial presentation. (A) Conjunctival injection, corneal edema and hypopyon were identified. (B) Heterogeneous vitreous opacity was observed.

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  Figure 2. Culture of aqueous humor and vitreous. (A) Pink‐ colored cottony colony on MacConkey agar after incubation. (B) Microscopic morphology of Raoultella planticola (Gram stain, ×1,000). (C) Scanning electron microscopy of Raoultella planticola.

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  Figure 3. Anterior segment photograph. (A) Slight corneal edema and no hypopyon were identified at 10 days after surgery. (B) Clear cornea and no inflammation were observed at 4 months after surgery.

Reference

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