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Last Month’s Blink

The Honeycomb Sign: Recurrent Enterococcus Faecalis Endophthalmitis

Written by Jordan Deaner, MD, Sophie Cai, MD, Frank Brodie, MD, MBA, Henry Feng, MD, Austin Meeker, MD, Terry Kim, MD, and Sharon Fekrat, MD. Photo by Paola Torres, COT, OCT-C. All are at Duke Eye Center, Durham, N.C.

A 65-year-old woman presented two days after undergoing combined Descemet mem­brane endothelial kerato­plasty, cataract extraction, and IOL implantation. She had hand-motion vision and severe anterior chamber and vitreous inflammation. She underwent a vitreous tap and intravitreal injection of vancomycin and ceftazi­dime for presumed post-op bacterial endoph­thalmitis. Her vitreous cultures grew Enterococcus faecalis. The patient initially responded to therapy, with vision improving to 20/150 and a quiet eye.

Two months later, she returned with increasing pain and worsening vision. Examination revealed a honeycomb organization of inflammatory and presumed infectious material on the posterior aspect of the posterior capsule that was concerning for recur­rent endophthalmitis (photo). She underwent a diagnostic and therapeutic pars plana vitrectomy with removal of the IOL-bag complex, along with intravitreal vancomy­cin and amikacin injection. Vitrectomy cultures were again positive for E. faecalis. Three months later, her vision recovered to 20/80. Now there is no evidence of recurrent infection or inflammation.

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