Sir,

We recently encountered a rare case of post-operative Ochrobactrum anthropi endophthalmitis potentially caused by percutaneous transluminal angioplasty (PTCA) prior to cataract surgery. O. anthropi has caused catheter-associated bacteraemia, osteochondritis, and pancreatic abscess.1, 2, 3 However, we identified only a single report of O. anthropi endophthalmitis following cataract surgery in the literature.4

A 75-year-old man was referred for chronic endophthalmitis following uneventful cataract extraction and posterior intraocular lens (IOL) placement in April 2006. Medical history included myocardial infarction and PTCA 1 year previously (3 weeks before cataract surgery). Low-grade intraocular inflammation was noted on post-operative day 9 and treated with steroid drops; yet pan-uveitis persisted for 9 months. Pars plana vitrectomy, intravitreal antibiotic injection, two anterior chamber taps, and intracameral antibiotic injection were performed; the initial tap revealed O. anthropi.

Our initial evaluation (April 2007) detected keratic precipitates on the endothelium, fine white conglomerates on the IOL, and diffuse debris in the vitreous. We performed complete capsulectomy, IOL removal, vitrectomy, and intravitreal vancomycin and amikacin injection. Vitreous and capsular bag cultures grew O. anthropi sensitive to ceftazidime, imipenem, ciprofloxacin, and trimethoprim. Therapy included intravenous Tieman and topical ciprofloxacin. The infection cleared, and vision recovered from 4/20 to 2/20 with spectacles.

Ochrobactrum anthropi sepsis usually occurs with indwelling catheters or other medical prostheses.5 Our patient could have been infected during cataract surgery or PTCA; O. anthropi infections manifesting within 3 weeks of central venous catheter placement and within 70 days of mitral valvuloplasty have been reported.6, 7 Our patient received PTCA 3 weeks before cataract surgery and symptoms occurred within 10 days. We assume that O. anthropi clustered in the vitreous first, then circulated to the anterior segment.

Our patient received cataract surgery at another clinic; so his blood culture results were unavailable. To reduce the risk of infection, surgeons should evaluate the patient's complete detailed medical history prior to surgery. A recent vascular catheter procedure represents a risk for O. anthropi infection.

Ochrobactrum anthropi is resistant to various antibiotics4 and post-cataract surgery-associated O. anthropi endophthalmitis has been treated by removing the IOL and residual capsule.4, 8 To clear the infection, the entire capsular bag must be removed.