Annie Mathai,¹ Virender S Sangwan,² Avinash Pathengay^1
1Srimati Kanuri Santhamma Retina Vitreous Centre, and ²Department of Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, India

A 67-year-old lady with keratoconus and cataract underwent uneventful phacoemulsification, posterior chamber intraocular lens implantation and penetrating keratoplasty in her left eye. On the first postoperative day, she developed symptoms and signs of endophthalmitis for which a vitreous biopsy was performed, followed by intravitreal injections of vancomycin and ceftazidime. Vitreous culture revealed multidrug-resistant Pseudomonas aeruginosa sensitive to piperacillin/tazobactam and imipenem. In 2 days, her vision deteriorated to light perception with a large corneal infiltrate and fulminant endophthalmitis. A therapeutic penetrating keratoplasty, intraocular lens explantation, open sky vitrectomy, and intravitreal injection of piperacillin/tazobactam was performed to salvage the eye. The antibiotic injection was repeated, and dexamethasone was given, after 4 days. The infection was controlled, the graft remained clear, and she regained a best-corrected visual acuity of 20/40 after 6 months.

Key words: Drug resistance, multiple, Endophthalmitis, Piperacillin-tazobactam combination product, Pseudomonas aeruginosa

Asian J Ophthalmol. 2007;9:185-187.