Vancomycin and ceftazidime deposits
C. Observation
This patient was referred for new retinal lesions after treatment for presumed bacterial endophthalmitis following cataract surgery. At the time of consultation, we opted to observe closely given the patient was improving clinically with decreased intraocular inflammation.
Repeat injection of intravitreal antibiotics (choice A) is not the preferred answer as the lesions developed following antibiotic treatment and she was improving clinically. Because the vitreous cultures provided a presumed diagnosis of S caprae endophthalmitis susceptible to vancomycin, injecting antifungals (choice D) would be unlikely to aid this patient.
Deposits similar to those seen in this case have been reported in 2 scenarios: (1) preretinal precipitates resulting from intravitreal injections and (2) epiretinal deposits in the setting of Cutibacterium acnes infection.1 Given her clinical improvement with resolving inflammation, an invasive procedure such as pars plana vitrectomy with vitreous biopsy (choice B) or capsular biopsy was not pursued and would be reserved for patients who may not otherwise be improving clinically, in whom a smoldering infection such as C acnes is suspected, or in whom the diagnosis remains uncertain. Our case differs from the epiretinal deposits seen with C acnes given the fulminant postcataract endophthalmitis that occurred, rather than the delayed-onset smoldering inflammation seen with C acnes. Additionally, this case lacked a posterior capsular plaque and there was notable improvement with eventual resolution of the deposits without further intervention.