Outbreak of Empedobacter brevis endophthalmitis after cataract extraction

Background: We present a series of patients who were operated upon on the same day by the same surgeon. All of those patients developed postoperative endophthalmitis due to Empedobacter brevis - a bacterium hitherto unknown in ophthalmologic literature. Methods: Twelve patients were referred because of endophthalmitis after cataract extraction. The patients' files were studied and the intraoperative and postoperative outcome was analysed. Results: Twelve patients (five male, seven female, mean age 75 years) presented 1-6 days after uncomplicated cataract extraction. Although some suffered from medical or ophthalmological diseases there was no association with the severity of the endophthalmitis. Eleven patients required vitrectomy, seven as primary procedure, one primary with extraction of the lens and three secondary after anterior chamber lavage and intravitreal antibiotics. In three cases vitrectomy had to be repeated together with extraction of the intraocular lens. There were two postoperative retinal detachments that required silicon oil and in one case an encircling band. Mean visual acuity rose from 0.02 to 0.47 by 9 months after operation. Empedobacter brevis was found in the anterior chamber and in the vitreous in all except one patient. Conclusion: In high-volume cataract surgery endemic endophthalmitis is always possible. Sources of infection may be anything from the lens to the sterilisation process, the latter being the primary suspect in our series. Prompt, adequate and (if necessary) aggressive treatment by vitreous surgery may lead to favourable results.