Rapidly Progressive Endogenous Endophthalmitis with Subretinal Abscess

ABSTRACT

PURPOSE: To report a case of a rapidly progressive endogenous endophthalmitis with subretinal abscess that involved the macula and was treated with early vitrectomy. CASE SUMMARY: A 42-year-old man with liver cirrhosis, hepatic cellular carcinoma and diabetes, who underwent regular fundus checkup for diabetic retinopathy presented with reduced vision, ocular pain in the left eye and headache. Indirect ophthalmoscopy showed subretinal abscess approximately five times the optic disc size and surrounding retinal hemorrhage in the nasal upper quadrant. A provisional diagnosis of bacterial endophthalmitis was made based on systemic disease and funduscopic findings. Treatment with topical and systemic empirical antibiotics was initiated along with intravitreal vancomycin and ceftazidime injection. Despite the treatment, after 24 hours the abscess size increased to approximately 10 times the optic disc size and began to involve the macula. The patient underwent diagnostic and therapeutic pars plana vitrectomy as well as vitreous and abscess content cultures. MRSA was found in a blood culture test. Five days postoperatively, the patient's vision and symptoms improved significantly and the residual lesion was cleared, with retinal scars. CONCLUSIONS: In a patient with endogenous endophthalmitis with subretinal abscess, presence of macular invasion and rate of progression is important in determining the time and method of operation. In this case, early vitrectomy was a good choice to preserve macular structure and the patient's visual acuity.