Pars plana vitrectomy for Borrelia burgdorferi endophthalmitis

Bcakground Ocular manifestations of Lyme borreliose present with unusual fo rms of conjunctivitis, keratitis, optic nerve disease, uveitis vitritis and rarely endophthalmitis. Case report A 57-year-old man working as logger in Saxony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of h is left eye was intact light perception and hand motions. The slit-lamp exa mination revealed severe inflammation of the anterior chamber with hypopyon , posterior synechiae, and opacity of the posterior lens capsule. Funduscop y showed no red reflex, no retinal details. In the local hospital serum ana lysis was performed and showed in Western-Blot IgM- and IgG-antibodies agai nst Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthal mitis developed when antib iotic therapy was finished. Results During pars plana vitrectomy a sharply delineated cystic lesion con taining yellowish fluid was revealed, and cremy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structu res consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment fo r 14 days we observed a retinal vasculitis in the follow up of 6 months. Conclusions Despite intravenous ceftriaxon-therapy borrelia burgdorferi mus t have survived in the vitreous body. Further investigations are required w ith respect to the use of other antibiotics or immunsuppressives.