Amphotericin B/antibacterials/methylprednisolone acetate
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Central serous retinal detachment: case report An 84-year-old man developed central serous retinal detachment during treatment with vancomycin, ceftazidime, methylprednisolone acetate, amphotericin B and amikacin for endophthalmitis, and linezolid for endophthalmitis secondary to Enterococcus faecium infection [not all dosages stated]. The man, who had moderate cataract, underwent phacoemulsification in the right eye. The case was complicated by posterior capsule rent; therefore, an anterior chamber intraocular lens was placed. After one week, he presented with corneal oedema, lacrimation and corneal infiltration with keratic precipitates with anterior chamber and vitreous haze. Based on these symptoms, endophthalmitis was considered. Therefore, a vitreous tap was obtained followed by intravitreal injection of vancomycin 1mg and ceftazidime 2mg, both in 0.1 mL. On the next day after the vancomycin and ceftazidime injection, he developed conjunctival hyperaemia, corneal oedema and striae, lid oedema along with worsened inflammatory reaction in the anterior chamber. There was no growth on vitreous cultures after 48h. On post-operative day 11, the corneal decompensation worsened. He again received intravitreal vancomycin and ceftazidime along with subconjunctival methylprednisolone acetate [Depomedrol] 0.5mL injection (containing 20mg of methylprednisolone acetate) and placed a bandage soft contact lens to manage the superficial corneal disease. Despite treatment (with vancomycin, ceftazidime and methylprednisolone acetate), there was no improvement. It was suspected that it might be fungal endophthalmitis; therefore, he received intravitreal amphotericin B injection on post-operative day 14 concomitantly with fluconazole. On post-operative day 16, there was no significant clinical improvement. Therefore, it was decided to perform three-port posterior vitrectomy, with repeat vancomycin injection. At the end of the procedure, a clear view of the retina was obtained. However, on the next day after the vitrectomy, the vitreous was observed to be filled with new greyish flocculent material, also involving the anterior chamber. Therefore, he again received ceftazidime and amphotericin B therapy. However, there was no improvement in his eye. On post-operative day 20, he underwent a second vitrectomy and then received intravitreal amikacin injection. The vitreous cultures again showed no growth. Subsequently, Enterococcus faecium infection was considered based on the direct gram stain test. Further testing showed that some strains of this organism were vancomycin resistant. He started receiving treatment with IV linezolid injection 600mg twice a day; however, linezolid therapy was stopped due to short of administering the medication into the vitreous. He then received treatment with oral linezolid 600mg tablets twice a day for the next 3 weeks. However, the cornea remained hazy with blotches of blood on the endothelium. Oral linezolid therapy did not prove efficacious. Additionally, he received supportive therapy with d
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