DOI: 10.1097/icb.0000000000001949 ISSN: 1935-1089

Chronic Actinomyces neuii endophthalmitis post-cataract surgery treated with intravenous and intramuscular antibiotics and intraocular lens explantation: case report and review of the literature

Carol Tadrous, Nadine Cheffi, Rishi B. Gupta, Jonathan B. Angel, Bernard R. Hurley, Chloe C. Gottlieb
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Purpose:

To report a case of recalcitrant Actinomyces neuii ( A. neuii ) chronic postoperative endophthalmitis (CPE) successfully treated with prolonged systemic penicillin therapy and intraocular lens (IOL) explantation, with pharmacokinetic confirmation of therapeutic intravitreal drug levels.

Methods:

Retrospective case report with focused literature review.

Results:

A 77-year-old male developed recurrent anterior uveitis and cystoid macular edema after uncomplicated cataract surgery. Vitreous cultures grew A. neuii . Despite repeated intravitreal antibiotics and vitrectomies, inflammation recurred over several years. Following infectious disease consultation, intravenous penicillin G (4 million units every 4 hours for 4 weeks) was administered, followed by intramuscular benzathine penicillin G (2.4 million units every 2 weeks for 6 months), in conjunction with IOL explantation. Intravitreal sampling four hours after intravenous dosing demonstrated penicillin G concentration of 3.5 μg/mL, exceeding published minimum inhibitory concentrations for Actinomyces species . Inflammation remained quiescent at long-term follow-up with visual acuity limited due to secondary complications from chronic macular edema.

Conclusion:

This case highlights the importance of systemic therapy and interdisciplinary management in recalcitrant CPE caused by unusual pathogens. Our approach, including prolonged intravenous and intramuscular antibiotic courses with confirmed therapeutic intraocular concentrations and IOL removal, proved effective for sustained resolution.

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