Favorable Outcome With Early Vitrectomy for Pseudomonas Endophthalmitis Following Elective Pars Plana Vitrectomy for Disabling Vitreous Opacities

Postvitrectomy endophthalmitis is a rare but vision-threatening complication, with reported incidence rates below 0.15%, and treatment guidelines remain limited. Evidence guiding the timing of repeat vitrectomy in this setting is sparse, and the approach to management is derived largely from postcataract endophthalmitis. Pseudomonas aeruginosa endophthalmitis is associated with characteristically poor visual outcomes, often including enucleation. A 58-year-old man with a history of insulin-dependent diabetes and proliferative diabetic retinopathy presented with conjunctival injection, corneal edema, hypopyon, and vitritis 2 days after elective 25-gauge pars plana vitrectomy for vitreous opacities. His visual acuity had dropped from a preoperative baseline of 20/30 to hand motion. The patient was initially treated with vitreous tap and intravitreal injection of vancomycin and amikacin at initial presentation of endophthalmitis and admitted for hourly topical moxifloxacin and prednisolone acetate 1%. Re-evaluation after 12 h showed persistently decreased vision and inflammation, with B-scan ultrasonography showing active vitritis without retinal detachment. He was taken for repeat vitrectomy with intravitreal antibiotic injection within 24 h of presentation. Vitreous culture was positive for Pseudomonas aeruginosa, which was susceptible to the empiric aminoglycoside. The patient's vision improved to 20/200 at 2 weeks, then to his baseline of 20/30 by 1 year postoperatively, remaining stable through a 3-year follow-up period. Early repeat vitrectomy within 24 h of endophthalmitis presentation and prompt intravitreal antibiotic therapy for patients with postvitrectomy gram-negative endophthalmitis can be associated with favorable visual outcomes. Early patient presentation, concordant antibiotic treatment, and absence of severe complications, such as retinal detachment or occlusive vasculitis, may have contributed to excellent recovery to baseline vision.