Chronic actinomyces neuii endophthalmitis postcataract surgery treated with intravenous and intramuscular antibiotics and intraocular lens explantation: case report and review of the literature
Abstract
Purpose: To report a case of recalcitrant Actinomyces neuii ( A. neuii ) chronic postoperative endophthalmitis successfully treated with prolonged systemic penicillin therapy and intraocular lens explantation, with pharmacokinetic confirmation of therapeutic intravitreal drug levels.
Methods: Retrospective case report with focused literature review.
Results: A 77-year-old man developed recurrent anterior uveitis and cystoid macular edema after uncomplicated cataract surgery. Vitreous cultures grew A. neuii . Despite repeated intravitreal antibiotics and vitrectomies, inflammation recurred over several years. After infectious disease consultation, IV penicillin G (4 million units every 4 hours for 4 weeks) was administered, followed by intramuscular benzathine penicillin G (2.4 million units every 2 weeks for 6 months), in conjunction with intraocular lens explantation. Intravitreal sampling 4 hours after IV dosing demonstrated penicillin G concentration of 3.5 µ g/mL, exceeding published minimum inhibitory concentrations for Actinomyces species . Inflammation remained quiescent at long-term follow-up with VA limited because of secondary complications from chronic macular edema.
Conclusion: This case highlights the importance of systemic therapy and interdisciplinary management in recalcitrant chronic postoperative endophthalmitis caused by unusual pathogens. Our approach, including prolonged IV and intramuscular antibiotic courses with confirmed therapeutic intraocular…
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