Chronic postoperative endophthalmitis caused by Kocuria rhizophila

Abstract

CASE An 89-year-old immunocompetent lady presented with reduced vision and pain in the right eye. She had hypertension and uncomplicated bilateral cataract surgery 14 years previously. On examination: visual acuity OD 6/18 and OS 6/24; intraocular pressure 6 mmHg OD and 9 mmHg OS, with 1+ cells in the right anterior chamber. Posterior segment examination was unremark-able for infective features. Endophthalmitis and intraocular in fl ammation were con fi ned to the right eye. The left eye showed no infective or in fl ammatory features but had a coexisting cystoid macular oedema (CMO) — presumed idiopathic given the 14-year interval since uneventful cataract surgery (not Irvine-Gass) — accounting for the reduced left visual acuity of 6/24. The left-eye CMO was treated with topical ketorolac (Acular) and dexamethasone (Maxidex), likely bene fi ting from oral corticosteroids prescribed for right-eye disease, and improved gradually. She was diagnosed with right anterior uveitis and commenced on topical prednisolone acetate 1%, initially hourly while awake and tapered stepwise in line with clinical response (four times daily for two weeks, then twice daily for two weeks, then once daily for two weeks before discontinuation). A cycloplegic was not prescribed as there was no signi fi cant ciliary spasm or photophobia, and review was arranged within 48 h. Baseline uveitis investigations (syphilis/HIV serology, ANCA, immunoglobulins, chest X-ray) were unremarkable except for raised IgA,