Epidemic Bacillus endophthalmitis after cataract surgery II: chronic and recurrent presentation and outcome.

Abstract

To report the clinical outcome of chronic Bacillus endophthalmitis after cataract surgery. Retrospective, noncomparative case series. Five eyes of five patients with late-onset or recurrent inflammation after exposure to bacteria-contaminated viscoelastic material were studied. Repeated vitrectomies, wide excision of the remnant posterior capsule, and intravitreal injections of antibiotics in five patients. Eventual explantation of the intraocular lens in four patients. Final visual acuities and results of microbiologic studies of aqueous and vitreous specimens as well as pathologic studies using hematoxylin-eosin, Gram, and periodic acid-Schiff (PAS) stain of explanted capsular remnants were obtained. Final visual acuity of 20/40 or better was obtained in three patients. Bacillus species were grown from two cases. PAS- and Gram-positive microorganisms were identified in the capsular tissue in three of four patients who had explantation of the intraocular lens. A chronic form of Bacillus endophthalmitis is described for the first time. The clinical outcome is similar to chronic endophthalmitis caused by other organisms.