Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6496-6500
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6496
Delayed-onset endophthalmitis associated with Achromobacter species developed in acute form several months after cataract surgery: Three case reports
Tae-Hoon Kim, Sang-Joon Lee, Ki-Yup Nam
Tae-Hoon Kim, Department of Ophthalmology, Kosin University Hospital, Busan 49267, South Korea
Sang-Joon Lee, Department of Ophthalmology, Kosin University, College of Medicine, Busan 49267, South Korea
Ki-Yup Nam, Department of Ophthalmology, Chungnam National Univeristy, College of Medicine, Daejeon 35015, South Korea
Ki-Yup Nam, Department of Ophthalmology, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
Author contributions: Nam KY designed the study; Kim TH and Nam KY contributed to the analysis and interpretation of data; Kim TH, Lee SJ, and Nam KY contributed to the collection of data; Kim TH and Nam KY drafted the manuscript; Lee SJ and Nam KY contributed to the critical review of the article; and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ki-Yup Nam, MD, PhD, Associated Professor, Department of Ophthalmology, Chungnam National Univeristy, College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon 35015, South Korea. oksnam1231@daum.net
Received: May 6, 2021
Peer-review started: May 6, 2021
First decision: October 16, 2021
Revised: October 26, 2021
Accepted: May 8, 2022
Article in press: May 8, 2022
Published online: July 6, 2022
Processing time: 414 Days and 2.4 Hours
Abstract
BACKGROUND

Achromobacter species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis. Delayed-onset Achromobacter species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare. Intraocular lens (IOL) removal is commonly recommended to treat Achromobacter species endophthalmitis, which is based on previous studies. Here, we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative Achromobacter species endophthalmitis that developed in an acute form.

CASE SUMMARY

Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier. They had undergone cataract surgery 5-18 mo prior. Best-corrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception. They showed conjunctival injection, inflammation in the anterior chamber (cell reaction 4+) and hypopyon formation. The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy, anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin. Before fluid infusion, a vitreous specimen was obtained. In all cases, the IOLs were not removed. Achromobacter species was detected on vitreous specimen culture. After surgery, the vitreous opacity decreased gradually and there was little retinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50 and 20/40.

CONCLUSION

Delayed onset postoperative endophthalmitis caused by Achromobacter species can appear in an acute form. All patients responded well to early vitrectomy and administration of empirical antibiotics including ceftazidime. There was no need for IOL removal during surgery.

Keywords: Achromobacter species; Chronic endophthalmitis; Postoperative endophthalmitis; Case report

Core Tip: Postoperative Achromobacter species endophthalmitis is rare, and it was reported that surgical treatment with intraocular lens (IOL) removal was necessary for the treatment. We experienced three cases of a very rare and unique form of Achromobacter species endophthalmitis which appeared in an acute presentation and developed more than several months after cataract surgery. Early vitrectomy with antibiotics treatment including ceftazidime resulted in a favorable prognosis. There was no need to remove the IOL unlike in previous reports. In cases of delayed onset of postoperative endophthalmitis in the acute form, Achromobacter species has to be considered as the causative strain. In these cases, the IOL removal may not be needed.