Propionibacterium acnes endophthalmitis requiring intraocular lens removal after failure of medical therapy

A 52-year-old Saudi man developed intraocular inflammation 7 weeks after uneventful phacoemulsification with implantation of a silicone posterior chamber intraocular lens (IOL). Cultures from the aqueous and vitreous were repeatedly negative, but a temporary response to intracameral and intravitreal injection of vancomycin was noted. A series of 6 intraocular injections given over 5 days failed to resolve the inflammation. It did, however, disappear after the IOL was removed. The IOL provided the only positive culture in this case of Propionibacterium acnes endophthalmitis. Nine months later, a posterior chamber poly(methyl methacrylate) IOL was implanted. Eighteen months later, the patient had no recurrences. He regained a visual acuity of 20/30, corresponding to his best postoperative result.