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CASE REPORT OF ABIOTROPHIA DEFECTIVA ENDOPHTHALMITIS AFTER REPEATED INJECTIONS OF DEXAMETHASONE INTRAVITREAL IMPLANT (OZURDEX)
- Source :
- RETINAL Cases & Brief Reports. 16:170-173
- Publication Year :
- 2022
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2022.
-
Abstract
- Purpose To present a case of endophthalmitis caused by Abiotrophia defectiva after repeated injections of dexamethasone intravitreal implant (Ozurdex), in a patient already on systemic immunosuppressive therapy, and discuss the management of this challenging situation. Methods Case report and review of literature. Results A 70-year-old female patient with history of idiopathic pulmonary fibrosis presented for urgent evaluation due to left eye vision loss and mild discomfort 12 days after receiving her seventh dexamethasone implant injection. Ocular history was pertinent for recurrent macular edema resulting from a remote branch vein occlusion. Twelve days after her last injection, visual acuity decreased from 20/30 to counting fingers at 5 feet. Slit-lamp examination showed anterior chamber cell without fibrinoid membranes or hypopyon. Within hours, the patient's clinical appearance progressed. A vitreous tap followed by intravitreal injection of vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) was performed. The culture from the vitreous sample revealed heavy growth of A. defectiva. Owing to limited improvement, patient was taken to the operating room, and the presence of a full-thickness scleral defect at the site of most recent dexamethasone implant injection was confirmed. Vitrectomy with removal of implant, closure of all sclerotomies, including nonhealing full-thickness scleral defect, and repeated intravitreal antibiotic injection were performed. At the 3-month follow-up, no inflammation was observed, but visual acuity remained poor. Conclusion Intravitreal dexamethasone implant-associated endophthalmitis in the setting of systemic immunosuppression is a rare and challenging situation. Both local and systemic immunosuppression may delay wound healing, predisposing to wound leakage and consequent endophthalmitis. Despite repeated intravitreal antimicrobial injection and vitrectomy with implant removal, A. defectiva endophthalmitis carried a poor visual outcome.
- Subjects :
- medicine.medical_specialty
genetic structures
medicine.medical_treatment
Vitrectomy
Hypopyon
01 natural sciences
Dexamethasone
03 medical and health sciences
0302 clinical medicine
Endophthalmitis
Abiotrophia
Ophthalmology
medicine
Dexamethasone Intravitreal Implant
Humans
0101 mathematics
Macular edema
Gram-Positive Bacterial Infections
Aged
Drug Implants
Abiotrophia defectiva
business.industry
010102 general mathematics
General Medicine
medicine.disease
eye diseases
Vein occlusion
Intravitreal Injections
030221 ophthalmology & optometry
Female
Implant
business
Subjects
Details
- ISSN :
- 19351089
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- RETINAL Cases & Brief Reports
- Accession number :
- edsair.doi.dedup.....98c6b3dfb1d5c713f23240984b295646