Burkholderia cepacia: A Cause of Post-Operative Endophthalmitis

Background

Intraocular infection from B. cepacia can be persistent and devastating, yet it is rarely discussed. We reviewed reported cases of post operative endophthalmitis due to B. cepacia to determine the clinical course and outcome of treatment.

Method and findings

Search was done for reported cases of culture proven Burkholderia cepacia ocular infection. Cases in which B. cepacia alone was associated with post operative endophthalmitis were identified and used for this analysis and review. Trauma associated cases, mixed microbial infections and other non-intraocular infections were excluded from the analysis. There were eight reports in literature over a 26 year period, including three case reports and five case series of post operative endophthalmitis secondary to B. cepacia, accounting for 34 cases in total. Majority of the cases (N=29 eyes, 85%) occurred post cataract extraction. Other cases were post filtering and cataract surgery 1 eye, post vitrectomy 3 eyes, post penetrating keratoplasty 1 eye and post intravitreal antiVEGF 1 eye. The visual outcome of treatment was 20/30 in two eyes (one each in post cataract surgery and post antiVEGF eyes). Several eyes had poor visual outcome. 14 eyes, 41% had a visual outcome of less than 6/60. Recurrence after initial treatment was a common clinical presentation, reported in 4 out of the 8 reports.

Conclusion

Though a rare cause of post-operative endophthalmitis, Burkholderia cepacia infection ought to be recognized as an important cause of gram negative infection occurring after intraocular surgery and results in considerable visual loss in several cases. Significant gaps still exist in the knowledge and best practice required to prevent recurrence and improve visual and anatomical outcome.

Author(s): Ogugua Ndubuisi Okonkwo, Adekunle Olubola Hassan and Toyin Akanbi

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