A 62-year-old woman reports gradual blurring of vision 4 months after uneventful phacoemulsification. There is minimal pain, low-grade granulomatous inflammation with mutton-fat keratic precipitates, and a distinct white plaque within the posterior lens capsule. Repeated steroid pulses give only temporary improvement. The most likely organism is:

• A Staphylococcus epidermidis
• B Candida albicans
• C Streptococcus pneumoniae
• D Cutibacterium (Propionibacterium) acnes ✓

Explanation

Delayed chronic postoperative endophthalmitis with a white intracapsular plaque and granulomatous inflammation is classic for Cutibacterium acnes, an anaerobic gram-positive rod sequestered within the capsular bag. It characteristically relapses after steroids alone. Definitive treatment often requires intracameral vancomycin with capsulectomy or pars plana vitrectomy to remove the sequestered organism. S. epidermidis causes acute disease within days, not a smouldering plaque.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.