Postoperative Endophthalmitis

An elderly patient with past medical history of quiescent birdshot chorioretinopathy on immunosuppressive therapy underwent uneventful cataract surgery in the right eye followed by intracameral injection of moxifloxacin at the end of the case. On postoperative day 4, the patient noted decreased vision and new onset floaters in the right eye. The patient’s visual acuity was count fingers in the right eye. Anterior segment exam was notable for moderate anterior chamber reaction with no hypopyon. Dilated fundus exam was notable for 3+ vitreous haze and cell, extensive whitening of the retinal vasculature, and diffuse retinal hemorrhages. The patient underwent anterior chamber paracentesis, vitreous tap, and intravitreal vancomycin and ceftazidime injections. The next day, the visual acuity in the right eye decreased to had motion, a hypopyon had formed, and vitreous haze and cell had worsened. Intravitreal dexamethasone was injected into the right eye and cultures of the vitreous aspirate grew Staphylococcus epidermidis that was resistant to moxifloxacin. One week after initial presentation, the patient’s visual acuity improved to 20/150. Two months post-operatively, the patient’s visual acuity improved to 20/40.

Presentation Date: 01/19/2023

Issue Date: 01/27/2023