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Br J Ophthalmol 1997;81:168 doi:10.1136/bjo.81.2.168c
  • Letter to the Editor

Morganella morganii postoperative endophthalmitis

  1. EMMETT T CUNNINGHAM, JR
  1. The Francis I Proctor Foundation and
  2. Department of Ophthalmology,
  3. University of California
  4. San Francisco School of Medicine,
  5. San Francisco, CA 94143, USA
  6. The Francis I Proctor Foundation and
  7. Department of Ophthalmology,
  8. University of California
  9. San Francisco School of Medicine,
  10. San Francisco, CA 94143, USA
  11. Department of Ophthalmology, University of California,
  12. San Francisco School of Medicine
  13. San Francisco, CA 94143, USA
  • Accepted 14 October 1996
  1. JOHN P WHITCHER
  1. The Francis I Proctor Foundation and
  2. Department of Ophthalmology,
  3. University of California
  4. San Francisco School of Medicine,
  5. San Francisco, CA 94143, USA
  6. The Francis I Proctor Foundation and
  7. Department of Ophthalmology,
  8. University of California
  9. San Francisco School of Medicine,
  10. San Francisco, CA 94143, USA
  11. Department of Ophthalmology, University of California,
  12. San Francisco School of Medicine
  13. San Francisco, CA 94143, USA
  • Accepted 14 October 1996
  1. ROBERT Y KIM
  1. The Francis I Proctor Foundation and
  2. Department of Ophthalmology,
  3. University of California
  4. San Francisco School of Medicine,
  5. San Francisco, CA 94143, USA
  6. The Francis I Proctor Foundation and
  7. Department of Ophthalmology,
  8. University of California
  9. San Francisco School of Medicine,
  10. San Francisco, CA 94143, USA
  11. Department of Ophthalmology, University of California,
  12. San Francisco School of Medicine
  13. San Francisco, CA 94143, USA
  1. Robert Y Kim, MD, Department of Ophthalmology, K-301, UCSF, School of Medicine, 10 Kirkham Street, San Francisco, CA 94143-0730, USA.
  • Accepted 14 October 1996

Editor,—Postoperative bacterial endophthalmitis is an uncommon but potentially blinding complication of intraocular surgery.1 Most postoperative endophthalmitis results from Gram positive organisms,2 although Gram negative organisms are now recognised to constitute from 15 to 30% of cases in some series.3 This stated, few cases ofMorganella morganii (formerly known asProteus) postoperative endophthalmitis have been reported, and all but one3 have had poor visual outcomes.2-6 We now describe a patient who developedM morganii endophthalmitis following uncomplicated extracapsular cataract extraction, and in whom early, aggressive treatment resulted in good initial visual recovery.

CASE REPORT

A 68-year-old Filipino woman with well controlled adult onset diabetes mellitus underwent uncomplicated extracapsular cataract extraction by phacoemulsification followed by placement of a posterior chamber intraocular lens. The skin and eye were prepared with povidone-iodine preoperatively. The patient failed to return for follow up for 3 days, at which time she presented with hand movement vision, marked corneal oedema, and a 4+ anterior chamber cell and flare with hypopyon (Hogan, Kimura, and Thygeson grading7). The intraocular pressure was normal. The fundus was not visible but ultrasound failed to demonstrate vitritis. The diagnosis of early postoperative endophthalmitis was made, and anterior chamber and vitreous aspirates were taken for Gram stain and culture. The patient was then treated with: (1) intravitreal vancomycin (1 mg/0.1 ml), ceftazidime (2.25 mg/0.1 ml), and dexamethasone (0.4 mg/0.1 ml); (2) subconjunctival vancomycin (25 mg/0.5 …

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