A patient reports gradual, mild blurring of vision three months after uneventful phacoemulsification. Examination shows quiet external eye, minimal inflammation, and a whitish plaque within the capsular bag behind the intraocular lens. The most likely organism is:

• A Candida albicans
• B Staphylococcus aureus
• C Haemophilus influenzae
• D Propionibacterium acnes ✓

Explanation

Propionibacterium acnes causes chronic indolent postoperative endophthalmitis weeks to months after surgery, with granulomatous keratic precipitates, low-grade vitritis, and its hallmark white intracapsular plaque where organisms sequester within residual lens fibres. Treatment requires partial capsulectomy with intravitreal vancomycin since the organism hides inside the bag. S. aureus and H. influenzae cause acute fulminant presentations, and Candida produces fluffy vitreous infiltrates without a capsular plaque.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.