Conservative approach in the management of chronic postoperative Propionibacterium acnes endophthalmitis: A case report with review of literature

• Main Authors: Saurabh Deshmukh, Ronel Soibam, Pritam Bawankar, Harsha Bhattacharjee, Surpriya Hawaibam, Krati Gupta, Jitendra Kumar, Chintan Desai
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: TNOA Journal of Ophthalmic Science and Research
• Subjects: chronic postoperative endophthalmitis; in-the-bag antibiotic; polymerase chain reaction; propionibacterium acnes
• Online Access: http://www.tnoajosr.com/article.asp?issn=2589-4528;year=2020;volume=58;issue=3;spage=200;epage=202;aulast=Deshmukh

Chronic endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens (IOL) implantation secondary to slow-growing organisms such as Propionibacterium acnes. A 68-year-old male presented with pain and diminution of vision 4 months after uneventful phacoemulsification with IOL implantation. Slit-lamp examination showed trace hypopyon, conjunctival congestion with anterior chamber cells and flare, vitreous haze, and posterior capsular plaque-like deposits suggestive of probable P. acnes endophthalmitis. Intravitreal antibiotics did not provide any relief. The diagnosis was confirmed using PCR on the aqueous aspirate. Intracameral and in-the-bag injection of antibiotic caused the resolution of infection and improvement in visual acuity. This report thus highlights that in-the-bag antibiotics can help conservatively manage this condition without the need for an invasive procedure like vitrectomy and IOL explantation.