|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 3 | Page : 134
Comment on chronic postoperative endophthalmitis with an unusual organism: Unconventional approach
Pradeep Kumar Panigrahi
Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Sikshya O Anusandhan (Deemed To Be) University, Bhubaneswar, Odisha, India
|Date of Submission||18-Jul-2021|
|Date of Decision||25-Jul-2021|
|Date of Acceptance||31-Jul-2021|
|Date of Web Publication||1-Dec-2022|
Pradeep Kumar Panigrahi
Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Sikshya O Anusandhan (Deemed To Be) University, 8-Kalinga Nagar, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Panigrahi PK. Comment on chronic postoperative endophthalmitis with an unusual organism: Unconventional approach. J Clin Ophthalmol Res 2022;10:134
|How to cite this URL:|
Panigrahi PK. Comment on chronic postoperative endophthalmitis with an unusual organism: Unconventional approach. J Clin Ophthalmol Res [serial online] 2022 [cited 2023 Jan 31];10:134. Available from: https://www.jcor.in/text.asp?2022/10/3/134/362498
With great interest, I went through the article titled “Chronic postoperative endophthalmitis with an unusual organism: Unconventional approach” by Maggon and Shahare. The authors have done a commendable job in managing a case of chronic postoperative endophthalmitis due to Bacillus sp. Bacillus species are a group of ubiquitous, Gram-positive, spore-bearing soil-inhabiting rods, which are commonly associated with food poisoning. Endophthalmitis due to Bacillus sp. commonly occurs following open globe injuries. Postoperative endophthalmitis due to Bacillus sp. is very rare and usually signifies a breach in the sterilization and aseptic measures. Postoperative endophthalmitis usually has a fulminant course with tissue destruction developing within a few hours of presentation, resulting in poor final visual prognosis. Most fulminant cases present with raised intraocular pressure and brownish exudates in the anterior chamber and vitreous. The brownish nature of the exudates represents necrosis of the uveal tissues signifying the high necrolytic properties of the offending organism.
Chronic postoperative endophthalmitis due to Bacillus sp. is extremely rare. The authors have mentioned that they are aware of only one such report. Tandon et al. have reported chronic endophthalmitis due to Bacillus circulans in an 80-year-old female who had undergone uncomplicated cataract surgery in her right eye 17 months back. Similar to the present case, chalky white deposits were noted covering the posterior lens capsule. The patient made full recovery following partial posterior capsulectomy and pars plana vitrectomy. Romero Aroca et al. have reported two cases of chronic endophthalmitis in pseudophakic patients due to Bacillus subtilis.
In the present case, the authors opted for early surgery though the visual acuity was not that bad. A more conservative approach of repeated intravitreal antibiotics could have been initially tried. However, this would not have got rid of the plaques present on the surface of the intraocular lens, and the patient would have presented with recurrent inflammation following stoppage of the medications. I would like to commend the authors for the aggressive approach followed, which resulted in complete restoration of vision. Ophthalmologists should be aware of the fact that not all Bacillus sp. can have a fulminant presentation. Some species such as B. circulans can present in a subacute and chronic manner and present in a manner similar to common pathogens associated with chronic endophthalmitis such as Propionibacterium acnes.
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Conflicts of interest
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| References|| |
Maggon R, Shahare KG. Chronic postoperative endophthalmitis with an unusual organism: Unconventional approach. J Clin Ophthalmol Res 2021;9:41-3. [Full text]
Chhabra S, Kunimoto DY, Kazi L, Regillo CD, Ho AC, Belmont J, et al.
Endophthalmitis after open globe injury: Microbiologic spectrum and susceptibilities of isolates. Am J Ophthalmol 2006;142:852-4.
Rishi E, Rishi P, Sengupta S, Jambulingam M, Madhavan HN, Gopal L, et al.
Acute postoperative Bacillus cereus endophthalmitis mimicking toxic anterior segment syndrome. Ophthalmology 2013;120:181-5.
Tandon A, Tay-Kearney ML, Metcalf C, McAllister L. Bacillus circulans
endophthalmitis. Clin Exp Ophthalmol 2001;29:92-3.
Romero Aroca P, Méndez Marín I, Salvar Serra M, Pujol Bajador I, Ballester Basterdie F. Endoftalmitis crónica en el seudofaco por Bacillus subtilis
[Chronic endophthalmitis in pseudophakic patients caused by Bacillus subtilis
]. Arch Soc Esp Oftalmol 2003;78:107-9.