IDCases
Acute bacterial endophthalmitis with focal vitritis at a nasal chandelier illumination port after scleral buckling
By Mori Y, Torikai T and Shiraishi A.
Abstract
Background
Chandelier-assisted scleral buckling (CSB) has been reported to offer enhanced fundus visualization and reduced operative time during retinal detachment repair compared with conventional methods. However, the required intraocular penetration creates a potential route for bacterial entry into the eye.
Case presentation
A 31-year-old man with high myopia presented with a rhegmatogenous retinal detachment involving the macula. He underwent urgent CSB using a 27-gauge chandelier positioned nasally at 5 o'clock. On postoperative day (POD) 10, a localized vitreous opacity appeared precisely at the insertion site. By POD 11, the opacity extended into the inferior vitreous cavity, consistent with acute postoperative endophthalmitis. Despite empirical intravitreal injections of vancomycin and ceftazidime with intensive topical moxifloxacin, the patient developed photophobia, ocular pain, and worsening vitritis on POD 12. An urgent lens-sparing pars plana vitrectomy was performed, and vitreous fluid cultures identified Staphylococcus epidermidis. Postoperatively, the inflammation subsided, and at 3 months, full retinal attachment was observed with a visual acuity of 20/16.
