Endogenous
endophthalmitis could lead to a devastating outcome without a prompt and appropriate management. We report a case of advanced endogenous Klebsiella pneumoniae
endophthalmitis with extensive subretinal
abscess that was successfully treated with a
vitrectomy.
CASE PRESENTATION: A systemically well 61-year-old man complained of ocular
pain and visual decrease in his right eye for eighteen days. Ophthalmic examination showed dense
inflammation in the anterior chamber and vitreous body. Systemic investigations discovered diabetes and no specific site of systemic
infection was found after hospitalization. The
inflammation continued to worsen after the intravitreal
antibiotic injection. Therefore, a pars plana
vitrectomy combined with
phacoemulsification was performed. Intraoperatively, a white elevated, fluffy mass with the overlying
retinal whitening and
necrosis was revealed in superior periphery. In addition to this, extensive
retinal hemorrhages and five adjacent subretinal whitish masses with exudative
retinal detachment were observed in the posterior pole and inferior quadrants, which were suggestive of extensive subretinal
abscess with intense overlying
retinal inflammation. The excision of white fluffy mass superiorly was performed without retinotomy and aspiration of extensive subretinal
abscess. The polymerase chain reaction of vitreous samples was positive for Klebsiella
pneumonia. Intravitreal 2 mg/0.1 ml
ceftazidime were repeated. Nine days after the surgery, the
inflammation significantly subsided and the retina reattached. The patient was in a stable condition at subsequent visit eight months later.
CONCLUSION: The delay in an accurate diagnosis and treatment caused extensive subretinal
abscess combined with endogenous
endophthalmitis. The treatment modality of subretinal
abscess is typically individualized to the patient's presentation. If the retina overlying the
abscess is not necrotic, the extensive subretinal
abscess can quickly absorbed after
vitrectomy, retinotomy with aspiration of the
abscess should be avoided to decrease the risk of
retinal detachment.