Management Options for Propionibacterium acnes Endophthalmitis

The authors reviewed the management of nine culture-proven cases of Propionibacterium acnes endophthalmitis which presented at an average of 4 months after extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC IOL) implantation. The initial signs included a white intracapsular plaque (9/9), vitritis (9/9), granulomatous uveitis (4/9), nongranulomatous uveitis (5/9), hypopyon (4/9), beaded fibrin strands in the anterior chamber (3/9), and diffuse intraretinal hemorrhages (2/9). A variety of management schemes were used in these patients, including the following: topical and intravenous antibiotics alone; intraocular and topical antibiotic administration; pars plana vitrectomy with capsulectomy and intraocular antibiotic administration; and removal of all capsular remnants with PC IOL removal or exchange. The final visual acuities ranged from 20/20 to 20/60 in six eyes and 20/200 to 20/400 in three eyes. This review suggests that a variety of management options for P. acnes endophthalmitis appear to be successful. Based on the authors' experience, an algorithm for future treatment is offered.