A Case of Staphylococcus lugdunensis Endophthalmitis after Cataract Surgery

PURPOSE: To report a case of Staphylococcus lugdunensis endophthalmitis following cataract extraction and intraocular lens implantation. CASE SUMMARY: A 59-year-old woman presented with unilateral vision impairment and eyeball pain in her left eye, thirteen days after phacoemulsification and posterior chamber intraocular lens implantation. Best-corrected visual acuity of her left eye was 20/200. Slit lamp examination of her left eye revealed a severe conjunctival injection, severe chamber reactions with exudative membranes, hypopyon (about 1 mm) in the anterior chamber, and the fundus was not visible. Before the patient was admitted to the hospital, we cultured samples of aqueous fluid and performed an intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, ceftazidime 2.0 mg/0.1 mL). However, on the next day, because the inflammatory reactions of the anterior chamber and vitreous cavity were not improved and Gram positive cocci was confirmed, we performed a pars plana vitrectomy and an additional intravitreal antibiotics injection (vancomycin 1.0 mg/0.1 mL, dexamethasone 0.5 mg/0.1 mL). Seven days after the surgery, Staphylococcus lugdunensis was identified in the aqueous fluids culture. 11 days after the surgery, her inflammation and symptoms were improved and therefore, she could be discharged. Three months after the surgery, best-corrected visual acuity of her left eye was 20/20 and there was no evidence of recurrence of endophthalmitis and no abnormal findings in her fundus.

Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

PURPOSE: To report the characteristics and surgical outcome of macular holes (MHs) that develop after rhegmatogenous retinal detachment (RRD) repair. METHODS: A retrospective chart review was performed in patients who developed a new full-thickness macular hole after RRD repair between May 2010 and July 2013. For eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for MH repair, main outcomes included macular attachment status and postoperative visual acuity. RESULTS: Fourteen full-thickness MHs were detected in a series of 2,815 eyes (0.49% prevalence) that had undergone prior RRD surgery. Ten MHs developed after primary vitrectomy and four after scleral bucking surgery. The fovea was detached in eight of the 14 eyes at the time of RRD. Fourteen of 14 eyes were managed by pars plana vitrectomy, internal limiting membrane peeling, and intravitreal gas tamponade, and 12 of 14 eyes achieved MH closure. Mean preoperative Snellen best-corrected visual acuity (BCVA) was 20/63 (+/-0.25). Nine of 14 eyes had an improvement in visual acuity of at least two Snellen lines, and five eyes remained unchanged. CONCLUSIONS: In this small retrospective study, the secondary MHs were found predominantly in foveal detachments after RRD repair, most commonly occurring after primary vitrectomy. In conclusion, the surgical outcome and postoperative visual acuity improvement were satisfactory, although the final BCVA depended on the macular status during the RRD.

A Case of Syphilitic Scleritis Initially Misdiagnosed as Noninfectious Nodular or Fungal Scleritis

PURPOSE: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. CASE SUMMARY: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topical and oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in the same eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematous nodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed to exclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroid and oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oral fluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discovered the patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABS IgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4 million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy, the pain and nodular erythematous lesions were completely resolved. CONCLUSIONS: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventional treatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated by steroid treatment but can be cured by proper anti-syphilitic chemotherapy.