Delayed-onset micrococcus luteus-induced postoperative endophthalmitis several months after cataract surgery: A case report

BACKGROUND: Micrococcus luteus (M. luteus)-induced endophthalmitis is very rare and and may present as either acute or chronic postoperative endophthalmitis. The aim of this study was to report a case of delayed-onset M. luteus-induced endophthalmitis that occurred several months after cataract surgery. CASE SUMMARY: A 78-year-old man presented with decreased vision, pain and redness in the right eye that had begun 3 days prior. He had undergone cataract surgery 4 mo prior. Visual acuity was counting fingers; slit-lamp examination revealed conjunctival injection, posterior corneal precipitates, anterior chamber inflammation (cell 4+), and hypopyon. Fundus examination revealed moderate vitreous haze. Urgent vitrectomy was performed for suspected infectious endophthalmitis, followed by vitreous irrigation with injections of antibiotics. On the postoperative day 1, anterior chamber cell decreased to 2+ and hypopyon was not observed on slit lamp examination. Six days postoperatively, the patient had recurrent eye pain, and the anterior chamber cell grade increased to 4+; hypopyon recurred in the anterior chamber, and whitish plaque was observed in the lens capsule. Therefore, the patient underwent intraocular lens (IOL) and lens capsule removal, followed by vitreous irrigation, antibiotics injection, and vitrectomy. M. luteus was identified from a lens capsule culture. CONCLUSION: In cases of delayed-onset M. luteus-induced endophthalmitis, early vitrectomy and removal of the IOL and lens capsule may be necessary.