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• W2163612779 abstract "A 79-year-old woman presented to the retina service after being referred by her general ophthalmologist because of decreased vision and pain in her right eye for 2 days. The patient had a medical history of hypertension and a hysterectomy 30 years earlier and had no ocular history. Two weeks prior to presentation, she had been in good health and had undergone a routine colonoscopy with no abnormal findings. On presentation, her vision was light perception, with an elevated intraocular pressure of 38 and a fixed and dilated pupil. Slit-lamp examination showed a shallow anterior chamber, hypopyon, and fibrin along the pupillary border. There was no view of the posterior pole and B-scan ultrasonography showed vitreous haze and no retinal detachment. The patient's left eye was normal, with a vision of 20/25. The patient was admitted to the hospital, and pars plana vitrectomy, lensectomy, capsulotomy, intravitreal antibiotic insertion, and air-fluid exchange with silicone oil were performed. A vitreous sample was sent for culture and sensitivity after phacoemulsification of the lens and capsultomy were complete. The posterior vitreous had copious pus, and after removal of this material, a detached and hemorrhagic retina was revealed. Laser retinopexy was performed after an air-fluid exchange with silicone oil. Vancomycin 1 mg and ceftazidime 2.25 mg in a volume of 0.1 mL were injected. During the postoperative period the patient developed eyelid swelling and severe chemosis, with moderate right ophthalmoplegia. She was started on IV vancomycin, Flagyl, and ciprofloxacin for periorbital cellulitis. An orbital CT scan showed pre- and postseptal fat stranding with no proptosis. The patient's echocardiogram did not reveal a source of infection, and blood cultures were all negative. Possible enucleation was discussed, but the patient declined this option. Laboratory cultures of the vitreous specimen showed E. coli sensitive to most antibiotics. The patient's periorbital cellulitis improved and she was discharged on 400 mg oral moxifloxacin. On follow-up examination, the infection had resolved, but she had no light perception and an ischemic retina. More than 14 million colonoscopies are performed annually in the United States and more than 170,000 in the province of Ontario alone.1Schultz S.E. Vinden C. Rabeneck L. Colonoscopy and flexible sigmoidoscopy practice patterns in Ontario: a population-based study.Can J Gastroenterol. 2007; 21: 431-434PubMed Google Scholar There is the theoretical risk of transient bacteremia resulting from any invasive procedure because of the breakage of skin or oral or intestinal mucosa. Thus, patients at risk for seeding of prosthetic devices or heart valves sometimes take prophylactic antibiotics before dental procedures. There have been no reports in the literature of endophthalmitis after colonoscopy. Streptococcus bovis is the second most common cause of bacterial endocarditis, but there are only 2 reports of S. bovis endophthalmitis: 1 in a patient with colon cancer and the other in a patient in whom it arose spontaneously.2Bleibel W. D'Silva K. Elhorr A. et al.Streptococcus bovis endophthalmitis: a unique presentation of colon cancer.Dig Dis Sci. 2007; 52: 2336-2339Crossref PubMed Scopus (13) Google Scholar, 3Hayasaka K. Nakamura H. Hayakawa K. Gaja T. A case of endogenous bacterial endophthalmitis caused by Streptococcus bovis.Int Ophthalmol. 2008; 28: 55-57Crossref PubMed Scopus (7) Google Scholar Most cases of exogenous bacterial endophthalmitis occur as complications of cataract surgery; 70% of cases are caused by coagulase-negative micrococci.4Han D.P. Wisniewski S.R. Wilson L.A. et al.Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study.Am J Ophthalmol. 1996; 122: 1-7Abstract Full Text PDF PubMed Scopus (577) Google Scholar Endogenous endophthalmitis occurs when organisms reach the eye via the bloodstream, and it accounts for only 2% to 6% of all cases of endophthalmitis.5Jackson T.L. Eykyn S.J. Graham E.M. Stanford M.R. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases.Surv Ophthalmol. 2003; 48: 403-423Abstract Full Text Full Text PDF PubMed Scopus (433) Google Scholar Most patients with endogenous bacterial endophthalmitis have underlying medical conditions, such as diabetes, cardiac disease, or malignancy, that may be undiagnosed at initial presentation.6Okada A.A. Johnson R.P. Liles W.C. Endogenous bacterial endophthalmitis: report of a ten-year retrospective study.Ophthalmology. 1994; 101: 832-838Abstract Full Text PDF PubMed Scopus (399) Google Scholar Extraocular foci of infection are also common, such as a liver abscess, meningitis, and endocarditis, and they are associated with an appreciable mortality rate.6Okada A.A. Johnson R.P. Liles W.C. Endogenous bacterial endophthalmitis: report of a ten-year retrospective study.Ophthalmology. 1994; 101: 832-838Abstract Full Text PDF PubMed Scopus (399) Google Scholar Escherichia coli endophthalmitis portends a poor visual prognosis and is unusual. There have been only 13 case reports in the literature since 1930, and the majority of the cases were caused by urinary tract infection.7Tseng C.Y. Liu P.Y. Shi Z.Y. et al.Endogenous endophthalmitis due to Escherichia coli: case report and review.Clin Infect Dis. 1996; 22: 1107-1108Crossref PubMed Scopus (17) Google Scholar Ophthalmologists must have a high level of suspicion in patients who present with endogenous endophthalmitis, and together with specialists on the medical team, must promptly diagnose and treat these infections to salvage the eye and useful vision. This is the first report of endogenous endophthalmitis after routine colonoscopy. In select patients, such as elderly and immunocompromised patients, prophylactic treatment may be indicated to avoid transient septicemia that could result in a potentially sight-threatening infection." @default.
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• W2163612779 title "Endogenous bacterial endophthalmitis after routine colonoscopy" @default.
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