Zeitschrift für klinische und experimentelle Ophthalmologie
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Abstrakt

Pseudomonas Keratitis from Phacolytic Glaucoma

Jingni Yu, Jianrong Liu,Xiaoli Wang, Xinguang Yang, Eric Chan, Justin Robert Nunez, XiongfeiLiu

Purpose: Phacolytic glaucoma is a secondary open angle glaucoma that is associated with hypermature cataract. The purpose of this study is to report a rare complication of phacolytic glaucoma.

Observations: A 70-year-old female was referred to us for elevated intraocular pressure (IOP) in the left eye. On exam, her left eye vision was light perception and IOP was 56 mmHg. Anterior segment exam was significant for 3+ conjunctival injection, microcystic edema, impending bullae, stromal edema, and deep chamber with 3+ cells, iridonesis, and mature cataract. Ultrasound biomicroscopy (UBM) confirmed open angle and iridescent particles in the anterior chamber. The diagnosis was phacolytic glaucoma. Oral methazolamide was started and trabeculectomy was scheduled in 2 days. However, patient developed microbial keratitis on the day of surgery. Despite fortified topical antibiotics, the keratitis worsened and led to endophthalmitis with orbital involvement, requiring eventual evisceration. Cornea culture came back positive for Pseudomonas aeruginosa Patient’s condition was stabilized after starting broad spectrum IV antibiotics.

Conclusions and Importance: Prolonged corneal edema with disrupted corneal epithelium from the temporary damage of high IOP on endothelium predisposed the eye to Pseudomonas aeruginosa that normally cannot infect intact epithelium. Therefore, care should be taken in determining the timing of and proper antibiotics course prior to surgery.