Postoperative Mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation

Objective: To describe a case of postoperative endophthalmitis caused by My cobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. Design: Interventional case report. Methods: The history and clinical presentation of a 66-year-old female pati ent, in whom a low-grade delayed-onset endophthalmitis and keratitis develo ped after extracapsular cataract extraction with posterior chamber intraocu lar lens implantation, is described. Microbiologic investigations of the sc rapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. Main Outcome Measures: The clinical, histopathologic, and microbiologic fin dings in a case of low-grade delayed-onset endophthalmitis. Results: Analysis of the direct smear of both the corneal infiltrate as wel l as the eviscerated material revealed acid-fast bacilli. M. chelonae was i solated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopatho logic examination of the eviscerated material showed a dense infiltration o f polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopatho logic examination of the lymph node revealed granulomatous inflammation wit h caseation necrosis, but did not reveal acid-fast bacilli. Conclusions: M. chelonae, although infrequent, should be considered an etio logic agent of delayed-onset, postoperative endophthalmitis and early bacte rial diagnosis should help in institution of appropriate therapy. (C) 2000 by the American Academy of Ophthalmology.