Susan Ruyu Qi^1,2*, Mélanie Hébert^1,2, Mike Yuan Chen³, Steve A Arshinoff^3,4 and Eric Tourville^1,2

¹Department of Ophthalmology, Hôpital du Saint-Sacrement, Quebec City, Canada
²Faculty of Medicine, Université Laval, Quebec City, Canada
³York Finch Eye Associates, Toronto, Ontario, Canada
⁴Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada

*Corresponding Author: Susan Ruyu Qi, Department of Ophthalmology, Hôpital du Saint-Sacrement, Quebec City, Canada.

Received: March 01, 2022; Published: March 25, 2022

Abstract

Introduction: Bilateral simultaneous postoperative endophthalmitis (BSPOE) is a rare but potentially devastating complication following immediately sequential bilateral cataract surgery (ISBCS). We present a case of BSPOE in an immunocompromised patient to suggest actionable precautions in this patient population.

Patient and clinical findings: A 79-year-old male with specific pneumococcal antibody deficiency underwent uneventful ISBCS with prophylactic intracameral 0.1 mL undiluted moxifloxacin 0.5%. The patient returned with decreased visual acuities of light perception in the right eye (OD) at 5 days and count fingers in the left eye (OS) at 7 days postoperatively with severe anterior chamber inflammation in each eye.

Diagnosis, Intervention, and Outcomes: The patient was diagnosed with BSPOE. Tap-and-inject was performed emergently on day 5 OD and day 7 OS with intravitreal vancomycin 1 mg/0.1 mL, dexamethasone 0.4 mg/0.1 mL, and ceftazidime 2.25 mg/0.1 mL. Cultures done OD were positive for methicillin-resistant coagulase-negative Staphylococcus epidermidis. The patient later underwent an anterior chamber washout, pars plana vitrectomy, and intravitreal injections of vancomycin 1 mg/0.1 mL and dexamethasone 0.04 mg/0.1 mL in both eyes (OU) and recovered 20/20 visual acuity OU at 6 weeks postoperatively.

Conclusions: This case raises critical issues about the adequacy of intracameral prophylaxis methods for immunosuppressed patients.

Keywords: Vancomycin; Bilateral Simultaneous Postoperative Endophthalmitis (BSPOE); Immediately Sequential Bilateral Cataract Surgery (ISBCS)

References

1. Chen MY., et al. “Bilateral simultaneous postoperative endophthalmitis (BSPOE): Review of cases reported over the past 50 years”. Journal of Cataract and Refractive Surgery (2021).
2. Brundrett A., et al. “Current Strategies for Prevention and Treatment of Postoperative Endophthalmitis”. Current Ophthalmology Reports 2 (2018): 105-114.
3. Arshinoff SA and Bastianelli PA. Incidence of postoperative endophthalmitis after immediate sequential bilateral cataract surgery”. Journal of Cataract and Refractive Surgery12 (2011): 2105-2114.
4. ISBCS | Eye Foundation of Canada Eye Foundation of Canada (2021).
5. Perez E., et al. “Specific antibody deficiency: Controversies in diagnosis and management”. Frontiers in Immunology 8 (2017): 1-11.
6. Perez EE and Ballow M. “Diagnosis and management of Specific Antibody Deficiency”. Immunology and Allergy Clinics of North America3 (2020): 499-510.
7. Youch M and Tichenor W. “Dangers of use of prophylactic antibiotics in patients with a primary immunodeficiency”. Annals of Allergy, Asthma and Immunology 5 (2018): S47-S48.
8. Hosseinverdi S., et al. “Ocular involvement in primary immunodeficiency diseases”. Journal of Clinical Immunology 1 (2021): 23-38.
9. Friling E., et al. “Postoperative Endophthalmitis in Immediate Sequential Bilateral Cataract Surgery: A Nationwide Registry Study”. Ophthalmology (2021).
10. Arshinoff SA and Modabber M. “Dose and administration of intracameral moxifloxacin for prophylaxis of postoperative endophthalmitis”. Journal of Cataract and Refractive Surgery12 (2016): 1730-1741.
11. Lukewich MK., et al. “Incremental effect of topical and oral moxifloxacin administration with surgical intracameral prophylaxis”. Canadian Journal of Ophthalmology (2021).
12. Arshinoff SA., et al. “Aqueous level abatement profiles of intracameral antibiotics: A comparative mathematical model of moxifloxacin, cefuroxime, and vancomycin with determination of relative efficacies”. Journal of Cataract and Refractive Surgery11 (2019): 1568-1574.
13. Shorstein NH and Gardner S. “Injection volume and intracameral moxifloxacin dose”. Journal of Cataract and Refractive Surgery10 (2019): 1498-1502.
14. Libre PE and Mathews S. “Endophthalmitis prophylaxis by intracameral antibiotics: In vitro model comparing vancomycin, cefuroxime, and moxifloxacin”. Journal of Cataract and Refractive Surgery 2017;43.6 (2017): 833-838.
15. Asbell PA., et al. “Antibiotic resistance among ocular pathogens in the United States five-year results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study”. JAMA Ophthalmology12 (2015): 1445-1454.

Citation

Citation: Susan Ruyu Qi., et al. “Bilateral Endophthalmitis After Immediately Sequential Bilateral Cataract Surgery (ISBCS) in an Immunodeficient Patient".Acta Scientific Ophthalmology 5.4 (2022): 73-76.

Copyright

Copyright: © 2022 Susan Ruyu Qi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.