Elsevier

Ophthalmology

Volume 106, Issue 12, 1 December 1999, Pages 2395-2401
Ophthalmology

Treatment strategies for postoperative Propionibacterium acnes endophthalmitis

Presented in part at the Association for Research in Vision and Ophthalmology annual meeting, Ft. Lauderdale, Florida, May 1999.
https://doi.org/10.1016/S0161-6420(99)90546-8Get rights and content

Abstract

Purpose

Propionibacterium acnes endophthalmitis after cataract extraction and posterior chamber intraocular lens (IOL) implantation is characterized by a chronic indolent course, frequently associated with recurrence after standard endophthalmitis treatment. This study was designed to evaluate the efficacy of various therapeutic methods in the treatment of primary and recurrent episodes of postoperative P. acnes endophthalmitis.

Design

Retrospective, noncomparative case series.

Participants

Twenty-five patients treated at Wills Eye Hospital for P. acnes endophthalmitis.

Methods

The authors retrospectively reviewed the clinical charts and microbiology files of all patients treated at Wills Eye Hospital between January 1991 and April 1998 with culture-proven P. acnes endophthalmitis after cataract extraction and posterior chamber IOL implantation.

Main outcome measures

Results of cultures and microbiologic examinations, efficacy of various treatment methods in the prevention of recurrent inflammatory episodes, and final visual outcome.

Results

Twenty-five patients who met inclusion criteria were identified; initial therapy consisted of 1 of the following: intraocular antibiotic (IOAB) injections alone (2 patients); IOAB combined with pars plana vitrectomy (PPV) (10 patients); IOAB and PPV combined with partial capsulectomy (9 patients); and IOAB, PPV, total capsulectomy, and IOL exchange (4 patients). Nearly half of the patients (10 of 21, or 48%) initially treated with IOAB alone (1 of 2), IOAB and PPV (5 of 10), and IOAB combined with PPV and partial capsulectomy (4 of 9) required further therapeutic interventions for recurrent disease. Retreatment with IOAB alone or combined with PPV and partial capsulectomy in these patients failed to eradicate the infection in three (75%) of four patients.

None of the patients (0 of 4) treated initially with total capsulectomy and IOL exchange required additional surgical intervention. Furthermore, none of the patients (0 of 13) who underwent total capsulectomy with IOL removal or exchange or IOL exchange alone as an initial, secondary, or tertiary treatment required further intervention.

Conclusion

In the authors’ series, approximately half of the patients with P. acnes endophthalmitis were treated successfully initially with nonsurgical or limited surgical intervention. All patients treated with total capsulectomy and IOL exchange or removal, either as an initial treatment or for recurrent disease, were cured. Removal of the entire capsular bag and the IOL may be performed as a definitive initial therapy and should be performed for recurrent inflammation.

Section snippets

Methods

We retrospectively reviewed the clinical charts and microbiology files of all patients treated at Wills Eye Hospital between January 1991 and April 1998 with culture-proven P. acnes endophthalmitis after cataract extraction and posterior chamber IOL implantation. The following data were collected for each patient: age; gender; presenting clinical features associated with the development of endophthalmitis; interval between surgery and onset of signs and symptoms; results of microbiologic

Results

Twenty-five patients met the inclusion criteria and participated in this study. Demographic data and presenting clinical features are presented in Table 1. Fourteen (56%) of the 25 patients were men; the average patient age was 69 years (range, 42–84 years). The average period between cataract extraction and onset of signs and symptoms of P. acnes in the 20 patients in whom this could be reliably determined was 18 weeks (range, 2 days–16 months); in many cases, it was difficult to distinguish

Discussion

Propionibacterium acnes is a gram-positive, anaerobic, pleomorphic bacillus that is part of the normal eyelid and conjunctival flora.6, 7, 8, 9 A fastidious organism,10 it is often difficult to culture; many cases of suspected P. acnes endophthalmitis, based on characteristic clinical presentation and microscopic examination of intraocular specimens, were not included in this study as they were culture-negative. Newer molecular biologic techniques such as the polymerase chain reaction have

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    Supported by the Heed Foundation, Cleveland, Ohio (GKS).

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