An 83-year-old monocular male presented with complaints of new floaters in his right eye. His visual acuity was counting fingers, intraocular pressure was 8 mmHg with 3+ cells in his anterior chamber, and a dense vitritis. Ultrasound confirmed vitritis with an attached retina. The patient was seen by a referring ophthalmologist the day before with similar complaints of floaters with visual acuity of 20/40 due to nuclear sclerosis.\nThe patient had been no light perception in his left eye for over a year due to endogeneous endophthalmitis from a fungal lung lesion. At that time, both vitreous and lung biopsies grew out S. apiospermum. Other than diabetes, a thorough infectious disease work-up revealed no other immunocompromising risk factors. The lung lesions were unchanged after a course of treatment, and the patient’s family did not want further work-up such as a re-biopsy due to the patient’s age. The patient was prescribed a maintenance dose of voriconazole 200 mg PO QD, but he was noncompliant and stopped taking his medicine.\nAt the time of presentation to our clinic, the patient had symptoms in his right eye for less than 24 h. An intravitreal biopsy was performed in conjunction with intravitreal voriconazole (100 μg/0.1 ml). Vitreous biopsy at this time grew out S. aspiospermum. The patient was also started on intravenous voriconazole. After 48 h with no improvement, the patient was brought to the operating room for a 23-gauge pars plana vitrectomy and repeat intravitreal voriconazole (100 μg/0.1 ml) injection. There were no intraretinal lesions seen at the time of surgery, although the view was hazy. The patient did not receive any intravitreal or oral steroids. His inflammation subsided slowly over the course of 3 weeks with moxifloxacin and prednisolone acetate eye drops. One month after presentation, his visual acuity returned to 20/40.
A 54-year-old female patient presented to us with pain,\nswelling of lids of the right eye (RE) associated with intense\nchemosis and congestion of the conjunctiva. She was a\nknown diabetic since 20 years and a hypertensive since\n15 years. She had received posterior subtenon triamcinolone\n20 mg injection with a 20-gauge veinflow canula in her RE\nimmediately following focal laser treatment 3 days back for\ndiabetic macular edema. At presentation her vision in RE was\nhand movement close to face (HMCF) and the same in the\nleft eye (LE). Intraocular pressure could not be measured in\nRE due to massive lid edema. It was recorded as 14 mmHg in\nLE. The RE revealed lid edema with erythema []. The\ntemperature of the overlying skin was raised but there was no\npalpable mass. The conjunctiva was congested and chemosed.\nExtraocular movements were limited in all directions of gaze\nin RE. In LE the movements were full in all directions. On\nforcibly lifting the upper lid of RE there was frank white\ntenacious discharge from the site of subtenon injection along\nwith necrosis of the surrounding conjunctiva and peripheral\ncorneal infiltrate []. Pupillary reaction was normal.\nPosterior segment examination showed proliferative diabetic\nretinopathy (PDR) with clinically significant macular edema\n(CSME) in both eyes.\nMicrobiological investigation of the discharge and infiltrate\nshowed the presence of gram-positive cocci in clusters but no\ngrowth was observed on culture. Her fasting blood sugar was\n284 mg% at presentation. Thereafter she was started on insulin\ninfusion along with intravenous ciprofloxacin 500 mg twice\ndaily, vancomycin 1 g twice a day and metrogyl 80 mg twice\ndaily along with topical moxifloxacin 0.3% six times a day and\natropine thrice a day. She had previously received injection\ncefazolin and ciprofloxacin elsewhere for 1 day. Computed\ntomography (CT) of head was consistent with diagnosis of\norbital abscess [] with no involvement of optic nerve.\nThere was no evidence of intracranial involvement.\nOver the next 3 days there was very little improvement. At\nthis moment oral linazolid 500 mg twice a day was added to the\ndrug regimen suspecting methicillin and vancomycin-resistant\nStaphylococcus aureus. There was remarkable improvement in\nthe ensuing 48 h. Lid edema reduced considerably along with\ndecrease in conjunctival chemosis and congestion. Extraocular\nmovements improved and the discharge was seemingly much\nless than before. The above treatment continued for a period\nof 7 days. At 3 weeks follow-up all parameters were normal\nexcept for adjacent conjunctival and corneal scarring [].\nVisual acuity improved to 20/200. There was no restriction of\nocular movements.