Intravitreal Therapy of Endogenous Endophthalmitis due to Urosepsis – A Case Report

Abstract

This case report describes a case of endogenous endophthalmitis in a 58 year old man upon a background of urosepsis and bronchitis. The patient was hospitalised at a department of internal medicine in another hospital. The day after admittance he was sent to our clinic for a consultation examination due to worsening of vision and pain in the left eye. The condition was diagnosed as endogenous endophthalmitis. Visual acuity at the first examination was hand movement in front of the eye. Intravitreal therapy was commenced with a combination of two antibiotics (ceftazidime 2 mg/ 0.1 ml and vancomycin 1 mg/0.1 ml) and an antimycotic agent (amphotericin B 10 μg/0.1 ml). Over the course of two weeks the patient received this antibiotic treatment intravitreally 3x in total. During the first application of antibiotics, material was sampled from the anterior chamber of the eye for a microbiological examination – the result was negative. The blood culture tested positive for staphylococcus aureus. Intravenous application of antibiotics (gentamicin 240 mg i.v. every 24 hours and amoxicillin with clavulanic acid 1.2 g i.v. every 8 hours) was set for two weeks, and then antibiotic treatment continued (ciprofloxacin 500 mg every 12 hours) and antimycotic therapy (itraconazole 100 mg every 12 hours) orally for 2 months. Four weeks after the beginning of therapy, visual acuity in the left eye was 20/100 and after two months 20/40. The study emphasises the advantage of multi-disciplinary co-operation.