Acute postoperative morganella morganii panophthalmitis

MAIN Sir, Endophthalmitis is an uncommon but serious complication of intraocular surgery, often resulting in severe visual loss.1 The endophthalmitis may progress to panophthalmitis if

medical or surgical therapy cannot control the infection. Strains of the _Morganella_ genus are a rare cause of panophthalmitis following trauma and cataract surgery.2 We describe a patient

who developed fulminant _Morganella morganii_ panophthalmitis following vitrectomy with resultant loss of vision. To our knowledge, this is the first reported case of _M. morganii_

panophthalmitis. CASE REPORT A 46-year-old Taiwanese male had sudden loss of vision in right eye for a day due to vitreous haemorrhage. On day 1 after pars plana vitrectomy, the fundus was

visible and the retina was well attached. Unfortunately, his visual acuity decreased to no light perception, and severe ocular pain with eyelid swelling developed rapidly within 2 days after

the operation. He was transferred to our hospital on day 4. On presentation, the patient eyelid appeared to be severely swollen and haemorrhagic chemosis was noted. Mucopurulent pus exuded

from the right eye. Acute postoperative panophthalmitis was diagnosed. Haemogram revealed leukocytosis (16 700/_μ_l) with neutrophils predominant by 80.9%. Pars plana vitrectomy with

anterior chamber irrigation and intravitreal delivery of vancomycin and ceftazidime was performed on day 5. Profuse pus was noted during the operation. Vitreous specimens were obtained for

smear and culture. Intravitreal injections of vancomycin (1 mg/0.1 ml) and ceftazidime (2 mg/0.1 ml) and subconjunctival injections of vancomycin (50 mg/0.5 cm3) and ceftazidime (125 mg/0.5 

cm3) were given at the end of the operation. Diffuse retinal whitening and hyperemic disc were noted intraoperatively. The patient's postoperative treatment regimen consisted of: (1)

subconjunctival vancomycin (50 mg/0.5 cm3) and ceftazidime (125 mg/0.5 cm3) every other day (2) intravenous cefazolin (1 g every 8 h) and gentamicin (80 mg every 12 h) and (3) topical

fortified vancomicin (50 mg/cm3) and ceftazidime (50 mg/cm3) every 1 h. However, his eye became more inflamed with mucopurulent discharge, and the ophthalmic examination was difficult to

perform due to severe periorbital swelling (Figure 1). Gram stain of vitreous specimens revealed numerous Gram negative rods (Figure 2), and culture of the anterior chamber aspirates and

vitreous specimens grew many _Morganella morganii_ colonies that were resistant to ampicillin and cefazolin using the disk diffusion method. The extraocular extension was noted by computed

tomography. The systemic antibiotic was then shifted to intravenous ceftriaxone (2 g every 12 h) 1 week after operation. Periorbital swelling with mucopurulent discharge decreased

dramatically after intravenous ceftriaxone use. His eye appeared quiet after a 2-week course of systemic and topical antibiotics with third-generation cephalosporin. Unfortunately, the

patient did not regain any vision despite this aggressive treatment. COMMENT _M. morganii_ is a Gram negative bacillus that belongs to the Enterobacteriaceae family. Within the

Enterobacteriaceae, the genus _Morganella_ is one member of the tribe Proteeae, which includes also the genera _Proteus_ and _Providencia_.3 _M. morganii_ is highly resistant bacillus

susceptible only to _β_-lactamase inhibitors. Strains are often resistant to first-generation cephalosporins.3 _M. morganii_ is a rare but usually devastating cause of postoperative

endophthalmitis.4, 5 In our patient, the clinical picture was fulminating. Even though the early intervention was performed, panopthalmitis with extraocular extension still developed

rapidly. The inflammation did not subside even with aggressive treatment till the third-generation cephalosporin was given intravenously. To our knowledge, this is the first reported case of

_M. morganii_ panophthalmitis. _M morganii_ is a rare aetiologic infectious agent. Very early intensive treatment including systemic antibiotic therapy with the third-generation

cephalosporin is the most important factor in the possible success of avoiding an eye with _M. morganii_ panophthalmitis from evisceration/enucleation. REFERENCES * Nick M, Laura K, Eric B .

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subclinical urinary tract infection. _J Cataract Refract Surg_ 2003; 29: 1011–1013. Article  Google Scholar  Download references AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of

Ophthalmology, National Taiwan University Hospital, # 7 Chung-Shan South Rd., Taipei, Taiwan T-J Wang & J-S Huang * Department of Laboratory Medicine and Internal Medicine, National

Taiwan University Hospital, Taipei, Taiwan P-R Hsueh Authors * T-J Wang View author publications You can also search for this author inPubMed Google Scholar * J-S Huang View author

publications You can also search for this author inPubMed Google Scholar * P-R Hsueh View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR

Correspondence to J-S Huang. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Wang, TJ., Huang, JS. & Hsueh, PR. Acute postoperative _Morganella

morganii_ panophthalmitis. _Eye_ 19, 713–715 (2005). https://doi.org/10.1038/sj.eye.6701613 Download citation * Published: 27 August 2004 * Issue Date: 01 June 2005 * DOI:

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