Abstract

P 022

Agrobacterium radiobacter endophthalmitis subsequent to penetrating keratoplasty and secondary intraocular lens implantation

Diana Buhlbuck1, Karsten Kasper1, Guiseppe Valenza2, Thomas Klink1, Gerd Geerling1
1Universitäts-Augenklinik Würzburg, 2Institut für Hygiene Würzburg, Würzburg

Objective
Endophthalmitis is a rare complication of penetrating keratoplasty and is often caused by candida albicans or gram-positive bacteria. We report on the extreme rarity of an endophthalmitis caused by the gram-negative Agrobacterium radiobacter, a member of the rhizobiaceae family, which was described as the origin of intraocular infection in only 4 further cases.
Methods
Case report: A 79-year-old female underwent a penetrating keratoplasty with scleral-sutured secondary PMMA lens implantation with double running 10.0 nylon sutures for a decompensated corneal graft. The reason for the primary transplantation was a severe streptococcus viridans keratitis. Vitreoretinal surgery with silicon oil and lens extraction was also performed in the past on this eye.
On the 2nd postoperative day a 2,4 mm high hypopyon and vitreal infiltration appeared without corneal involvement. Agrobacterium radiobacter was detected in an anterior chamber and vitreous tap.
Results
The intraocular inflammation with hypopyon persisted despite three anterior chamber lavages with cefotaxim / vancomycin and systemic administration of cefotiam / ciprofloxacin plus topical gentamicin and ofloxacin. Only with the injection of 0,4 mg amicacin, 0,4 mg dexamethason in the anterior chamber and the vitreous cavity as well as i.v.-therapy with ciprofloxacin, imipenem und cilastatin based on the performed susceptibility screening was longterm recovery achieved. The graft cleared up under therapy with dexamethason 0,1% and lubricants. 3 weeks later visual acuity had improved to 0,1 with a clear graft. The culture of the corneoscleral rim showed no growth after 4 weeks.
Conclusions
This is the first report about an endophthalmitis caused by Agrobacterium radiobacter after keratoplasty. The agent is often multiresistent and grows preferential on plastic foreign bodies. In the other 4 cases the process was reported to be chronic. The combination of keratoplasty with secondary PMMA-lens implantation in addition to patient-intrinsic factors may have initiated this acute and rare form of endophthalmitis.

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