PMC2913728_01
(a): Patient's B-mode ultrasonography, which shows areas of increased echogenicity in the vitreous cavity. (b) Vitreous cavity sample gram stain that shows gran-positive cocci. ((c) and (d)) Antibiotic sensitivity tests. Blue arrow head: mild bacterial growth inhibition secondary to moxifloxacin disc. Yellow arrows: complete bacterial growth inhibition due to ampicillin sodium disc.
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The ultrasound examination revealed images of increased echogenicity which correspond to cellularity in vitreous cavity, pseudomembranes formation, and choroidal thickening (Figure 1(a)). At the same day, the microbiology department reported the presence of gram-positive cocci in the vitreous cavity sample (which was classified as Streptococcus uberis two days later (Figure 1(b)). The sensitivity test documented resistance to cephalothin, cefotaxime, ceftazidime, cefuroxime, dicloxacillin, vancomycin, azithromycin, clarithromycin, erythromycin, amikacin, gentamicin, netilmicin, tobramycin, clindamycin polymyxin, ciprofloxacin, gatifloxacin, moxifloxacin, ofloxacin, perfloxacin, and tetracycline (Figures 1(c) and 1(d)).
Patient's clinical evolution: ((a) and (c)) previous air-fluid interchange and intravitreal ampicillin sodium; the anterior segment biomicroscopy showed severe conjunctival hyperemia, severe cellularity, and Hypopyon with a fibrin clot on the surface of the intraocular lens. The details of the retina cannot be observed due to significant posterior opacities. However, the optic nerve seems to be extremely pale with severe attenuation of the blood vessels. ((b) and (d)) Four weeks after second surgery; anterior segment biomicroscopy showed an improvement in conjunctival hyperemia (mild), with disappearance of Hypopyon and fibrin cloth, and the retina showed extensive areas of photocoagulation (first surgery), severe pallor of the optic nerve, bloodless vessels, and vitreous cavity filled with silicon oil.
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Four weeks later, the integrity of the eye was preserved but the vision remained no light perception (Figure 2).