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Case Reports
. 2010 Sep 21;1(2):56-62.
doi: 10.1159/000320601.

Two Cases of Endogenous Endophthalmitis Caused by Gram-Positive Bacteria with Good Visual Outcome

Machiko Itoh  1 , Junko Ikewaki, Kenichi Kimoto, Yuji Itoh, Kei Shinoda, Kazuo Nakatsuka
Affiliations
Case Reports

Two Cases of Endogenous Endophthalmitis Caused by Gram-Positive Bacteria with Good Visual Outcome

Machiko Itoh et al. Case Rep Ophthalmol. .

Abstract

BACKGROUND: Endogenous endophthalmitis is a rare disease and its visual prognosis is poor. CASE REPORTS: We present two patients, a 60-year-old man and a 53-year-old man, who developed endogenous endophthalmitis caused by Gram-positive organisms but recovered good vision after antibiotics and vitrectomy. RESULTS: The first patient complained of ocular pain and visual decrease in his right eye. Ophthalmoscopy showed inflammation in the anterior chamber and vitreous opacities. Antibiotic was administrated systemically, and blood culture detected Streptococcus anginosus. He underwent successful heart surgery for endocarditis and total dental extraction for severe gingivitis. Vitrectomy was performed 36 days after the onset and vision improved from 0.02 to 0.7. The second patient was referred for acute visual decrease in his left eye. Severe iritis and vitreous opacities were observed, and systemic examination showed acute pyelitis and prostatic abscesses. Blood cultures detected Staphylococcus sp., and systemic antibiotics were given. Vitrectomy was performed 12 days after the onset, and vision improved from 0.06 to 1.2. CONCLUSIONS: We conclude that the rapid treatment with systemic antibiotics for the organisms at the primary site, and the vitrectomy, even though delayed, can lead to a good recovery of vision.

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Figures

Fig. 1
Fig. 1
Ophthalmological findings of case 1 at onset. a US showed no retinal detachment but an aggregated intravitreal mass in the right eye. b Ophthalmoscopy showed a white mass on the fovea in the left eye. c Optical coherence tomography showed that the white mass shown in b was continuous with the outer retinal layer. d Single-flash ERG showed almost no response in the right eye and normal responses in the left eye.
Fig. 2
Fig. 2
Ophthalmological findings of case 2. a US showed no retinal detachment but dense vitreal opacity in the left eye. b Single-flash ERG showed severely attenuated a-wave in the left eye. c Fundus photograph of the nasal region in the left eye taken 4 weeks after vitrectomy shows a scar where the subretinal abscess was resected. d Fundus photograph taken 4 weeks after vitrectomy shows no abnormal findings in the left eye.
See this image and copyright information in PMC

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