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Case Reports: Rare disease
Silicone oil tamponade in managing recalcitrant endophthalmitis after cataract surgery secondary to Clostridium intestinale
  1. Sara E Francomacaro1,
  2. Janani Singaravelu2,
  3. Rithwick Rajagopal2 and
  4. Albert S Li2,3
  1. 1Department of Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2John F. Hardesty, MD, Department of Ophthalmology & Visual Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  3. 3Vitreoretinal Consultants of New York, Northwell Health Eye Institute, Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
  1. Correspondence to Dr Albert S Li; AlbertLiMD{at}gmail.com

Abstract

A woman presented two weeks after uncomplicated cataract surgery with decreased visual acuity from endophthalmitis. One week after initial management with intravitreal antibiotics, her visual acuity decreased further, undergoing pars plana vitrectomy with intravitreal and intravenous antimicrobial coverage with preliminary improvement. Three days after vitrectomy, her vision decreased with recurrent inflammation. Initial cultures grew Clostridium intestinale. She underwent repeat vitrectomy with silicone oil tamponade with no subsequent recurrence. The silicone oil was removed after 4 months and her visual acuity returned to 20/20 after 1 month and through 1 year of follow-up. Postoperative endophthalmitis is rare, with cases due to Clostridium species particularly destructive. In this first reported case of C. intestinale endophthalmitis, conventional management did not achieve lasting quiescence until silicone oil tamponade was employed. Pars plana vitrectomy with silicone oil tamponade should be considered in the management of recurrent endophthalmitis or endophthalmitis secondary to a recalcitrant microbe.

  • Retina
  • Infectious diseases
  • Ultrasonography

https://doi.org/10.1136/bcr-2022-251462

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    Footnotes

    • Twitter @AlbertLiMD

    • Contributors SEF performed the literature review, created the figures, was a major contributor in writing the manuscript. JS acquired data for the manuscript and was a major contributor in writing the manuscript. RR participated in the care of this patient and was involved in revising the manuscript. ASL participated in the care of this patient, made substantial contributions to the conception of the manuscript, and substantively revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.