Kytococcus schroeteri Chronic Post-Operative Endophthalmitis After Cataract Surgery: The First Report of Ocular Kytococcus Infection.

Abstract

Purpose: To report the first case of Kytococcus schroeteri ocular infection manifesting as chronic post-operative endophthalmitis (CPOE) following routine phacoemulsification with intraocular lens (IOL) implantation. This gram-positive bacterium is recognised as a cause of hardware infections in immunocompetent hosts, such as prosthetic cardiac valves, ventriculoperitoneal shunts, and orthopaedic hardware, often necessitating surgical removal of the infected prostheses for cure.

Methods: Case report and literature review.

Results: A 64-year-old male with a history of uncomplicated cataract extraction and IOL insertion had multiple presentations over 6 years, with relapsing-remitting intraocular inflammation with multiple negative vitreous cultures treated as non-infectious panuveitis. An eventual positive vitreous culture for K. schroeteri led to a diagnosis of CPOE, which was successfully treated with vitrectomy, removal of IOL, and intravitreal vancomycin injections. However, advanced vision loss occurred due to secondary glaucoma.

Conclusion: K. schroeteri is a novel cause of CPOE, which is typically attributed to other low virulence organisms. As with infections of non-ocular implanted hardware by K. schroeteri, surgical removal of the infected IOL-capsule complex was required for cure. The CPOE diagnosis requires a combination of high index of suspicion and culture of vitreous and capsular material. The role of IOL removal for the treatment of CPOE is discussed.