Bacterial subretinal abscess: A case report and review of the literature

PURPOSE: To report a case of Klebsiella subretinal abscess with a successfu l visual outcome with treatment and to review the literature pertaining to focal intraocu lar infection in bacterial endophthalmitis, METHODS: Clinical data including medical history, findings on physical exam ination, blood cultures, and an abdominal computed tomographic scan were co llected in a 32-year-old man with Klebsiella sepsis, liver abscesses, and a focal subretinal abscess. Ocular data including visual acuity, fundus phot ographs, fluorescein angiography, and ultrasound were evaluated, as were re sults of culture and histopathologic studies. RESULTS: Despite immediate intervention, including vitreous tap and intravi treal antibiotics, the eye deterio rated, with enlargement of the abscess. A pars plana vitrectomy was performed in which the subretinal abscess mater ial was removed after an extensive retinectomy of the involved area in asso ciation with an endophotocoagulative barrier and intravitreal amikacin with out gas or oil tamponade, Culture confirmed Klebsiella subretinal infection . A retinal detachment occurred 1 month postoperatively and was successfull y repaired. Visual acuity was 20/30 and has remained stable for 14 months. CONCLUSION: Klebsiella endophthalmitis with subretinal abscess formation is a rare but devastating ocular condition. In the present case, prompt inter vention with extensive retinectomy, complete abscess excision, and intravit real antibiotic therapy resulted in unprecedented visual recovery. (C) 2000 by Elsevier Science Inc. All rights reserved.