Propionibacterium acnes chronic pseudophakic endophthalmitis

ABSTRACT

Propionibacterium acnes [P. acnes] is a slow-growing, anaerobic, gram-positive bacillus. P. acnes is a well recognized cause of delayed-onset, chronic endophthalmitis. It should be considered in all pseudophakic patients with chronic intraocular inflammation. The diagnosis of P. acnes endophthalmitis requires a high index of suspicion. Cultures requiring an incubation period of 10 to 14 days are necessary for definitive diagnosis. Polymerase chain reaction [PCR] carries high sensitivity and specificity rates, and is more sensitive than aqueous or vitreous cultures. A long-term follow-up period is needed to evaluate the efficacy of treatment strategies of P. acnes endophthalmitis. Reasonable treatment choices include pars plana vitrectomy and intravitreal antibiotics with either partial or total capsulectomy and intraocular lens [IOL] exchange or removal. Total capsulectomy with IOL exchange or removal almost always leads to a cure