A Rare Case Of Refractory Staphylococcus Hominis Endophthalmitis Following Cataract Surgery

To report an unusual case of delayed-onset, refractory endophthalmitis caused by Staphylococcus hominis following uncomplicated cataract surgery, characterized by recurrent anterior chamber hypopyon and corneal infiltration requiring tectonic keratoplasty for definitive management.

Sussex Eye Hospital, Brighton, UK

A 74-year-old underwent uncomplicated phacoemulsification with intraocular lens implantation, achieving 6/6 vision at one month postoperatively. The patient subsequently developed acute vision loss with clinical endophthalmitis. Despite multiple interventions, including vitreous tap, two pars plana vitrectomies, intravitreal antibiotics, and intensive topical therapy, the infection persisted for 5 months, with recurrent corneal wound infiltration and hypopyon. All initial vitreous and aqueous cultures remained negative. Following referral to our center, sequential anterior chamber washes, corneal biopsies, and intracameral antibiotics were performed. Staphylococcus hominis was eventually isolated from corneal sampling.

After identification of S. hominis, treatment was converted to systemic linezolid and intensive topical vancomycin. Given persistent corneal involvement despite maximal medical therapy, a superior 6mm tectonic keratoplasty was performed. Following this definitive surgical intervention combined with targeted antimicrobial therapy, the infection was successfully controlled, and intraocular inflammation was completely resolved.

This is the first reported case of S. hominis endophthalmitis presenting with recurrent anterior chamber hypopyon and corneal involvement despite broad-spectrum antibiotic treatment, which was successfully treated with tectonic keratoplasty. The case highlights that S. hominis should be considered in persistent postoperative endophthalmitis, and that tectonic keratoplasty may be required for definitive source control when medical therapy fails to eradicate ongoing infection and inflammation.