Medical management of a subretinal Klebsiella pneumoniae abscess with excellent visual outcome without performing vitrectomy

Abstract

Objective: To report the case of a Klebsiella pneumoniae endogenous endophthalmitis (KPEE) of hepatic and urinary origin that was successfully treated with systemic antibiotherapy and 13 intravitreal antibiotics injections without performing a vitrectomy.

Patient and method: Case report of a 60-year-old man with a subretinal abscess in the left eye that developed 3 days after initial presentation for K. pneumoniae bacteremia, liver abscess and urinary tract infection.

Results: Ophthalmic examination of the left eye showed anterior uveitis and a single subretinal abscess located in mid-peripheral temporal retina. BCVA dropped to 20/50. Follow-up was made with clinical examination and multimodal imaging (SD-OCT, FA, ICGA) with high field photographs. A total of 13 intravitreal injections (IVI) of ceftazidime were performed, and no vitrectomy was required. Ocular signs regressed and prognosis was excellent with 20/20 of final BCVA.

Conclusion: KPEE is a rare but severe condition with a typically poor ocular prognosis. When diagnosis is made early, subretinal abscess with partially conserved BCVA could be treated successfully with medical management that includes systemic antibiotics and repeated intravitreal injections without requiring vitrectomy.

Keywords: Abcès sous-rétinien; Bon résultat visuel; Endogenous endophthalmitis; Endophtalmie endogène; Good visual outcome; High field photography; Injections intravitréennes; Intravitreal injections; Klebsiella pneumoniae; Photographie en champ élevé; Sub retinal abscess; Vitrectomie; Vitrectomy.