Scientific Poster

Streptococcus Sanguinis Endophthalmitis After Cataract Surgery by Min Ho Shin, In Young Chung, Hyun Ji Kang, Ji Seong Jung, Woong Sun Yoo, South Korea

Min Ho Shin, In Young Chung, Hyun Ji Kang, Ji Seong Jung, Woong Sun Yoo, South Korea

Introduction:
Endophthalmitis is one of the most serious complications that can occur after cataract surgery, and may result in permanent visual impairment despite adequate treatment. Gram-positive bacteria such as Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus species are the most common causative organism. Streptococcus sanguinis, previously known as S. sanguis, is a gram-positive,nonspore-forming, facultative anaerobe and a member of the viridans group of Streptococci. S. sanguinis is a well known causative organism of infective endocarditis, but in other organs infection secondary to S. sanguinis is rare. To the best of our knowledge, there was no case report about S. Sanguinis endophthalmitis.

Case Report:
A 84-year-old male presented with visual disturbance and tenderness in his left eye two days after phacoemulsification and posterior chamber intraocular lens implantation. On systemic medical history, he had a hypertension and underwent colon cancer surgery 14 months ago. On examination, the best corrected visual acuity (BCVA) was 20/30 and light perception (LP). Intraocular pressure (IOP) was 15mmHg and 26mmHg. Anterior segment exam revealed conjunctival injection, corneal edema, keratic precipitates, anterior chamber (AC) cells (4+), hypopyon and inflammatory membranes in his left eye. Vitreous opacity was prominent on B scan ultrasonography (Fig 1B). Pars plana vitrectomy (PPV) with complete capsulectomy, intraocular lens (IOL) removal, anterior chamber and vitreous tapping and intravitreal antibiotics injection (vancomycin and ceftazidime) were performed. Intraoperative fundus examination showed punctate retinal hemorrhage and retinal vascular sheathing. In gram stain, many gram positive cocci were detected in vitreous. Microbial culture of vitreous fluid, aqueous fluid and intraocularlens all revealed S. sanguinis. According to antibiotic susceptibility test, intramuscular penicillin G was administered and topical antibiotics were maintained. Blood culture, oral cavity culture, echocardiography revealed no specific abnomality. About two weeks after vitrectomy, AC cell decreased to 2+ and hypopyon was absorbed completely and vitreous opacity was decreased prominently. Two months after vitrectomy, BCVA was 20/60 and no recurrence was observed.

Conclusion:
In conclusion, we report a case of Streptococcus Sanguinis endophthalmitis after cataract surgery treated successfully through early vitrectomy and intravitreal antibiotics injection.

Contact Details:
Min Ho Shin
Chosun University Hospital
Gwangju
South Korea
Cell Phone : +82-10-4602-8088
Work Phone : +82-62-220-3190
Email : god1048576@naver.com