Purpose: To report a rare case of Abiotrophia defectiva bleb-associated endophthalmitis.
Methods: In this case report of a patient with bleb-associated endophthalmitis, the authors describe the features of severe and rapid onset, associated retinitis, and a favorable outcome after aggressive early intervention.
Results: A 75-year-old woman presented decreased visual acuity of hand motions with an elevated intraocular pressure of 39 mmHg in the left eye. Her ocular history was notable for severe primary open-angle glaucoma with uneventful trabeculectomy and cataract surgery in both eyes 7 years before. Examination revealed conjunctival injection and an opaque avascular cystic bleb along with anterior chamber cellular reaction with a B-scan ultrasound concerning for vitritis. A. defectiva was isolated from the vitreous tap within 48 hours and confirmed later with 16S ribosomal RNA sequencing. After initial vitreous tap and inject and subsequent pars plana vitrectomy, her best-corrected visual acuity had improved to 20/500 at postoperative week one and then improved to 20/40 at postoperative month 2. Her examination was notable for resolved corneal edema, a deep and quiet anterior chamber, and resolved intraretinal hemorrhages.
Conclusion: This is one of the first bleb-associated endophthalmitis cases with rapid identification of A. defectiva . A. defectiva was isolated from the initial vitreous tap within 48 hours and confirmed with 16S ribosomal RNA sequencing. This case highlights that rapid identification of A. defectiva may be indicative of a greater bacterial load and should prompt aggressive intervention and that the visual prognosis can be favorable.