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Ophthalmology · Uvea: chronic postoperative endophthalmitis
Sample itemEight weeks after uneventful cataract surgery, an eye has low-grade granulomatous inflammation with a white plaque on the posterior capsule. It improves on steroids and relapses when they are tapered. Which organism is likely?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Propionibacterium acnes
Delayed, low-grade endophthalmitis with a capsular plaque that relapses after steroid taper suggests Propionibacterium acnes, a slow-growing anaerobe sequestered in the capsular bag. Cure usually needs vitrectomy, capsulectomy and intravitreal antibiotics.
Option by option
A. Propionibacterium acnes (correct)
Correct. A capsular plaque with steroid-responsive, relapsing inflammation is typical of this organism.
B. Candida albicans
Candida albicans causes fungal infection with fluffy vitreous opacities, usually in patients with a risk factor such as a central line.
C. Staphylococcus epidermidis
Staphylococcus epidermidis typically causes an acute endophthalmitis within days, not a weeks-later plaque.
D. Bacillus cereus
Bacillus cereus causes a fulminant endophthalmitis within 24 hours, usually after trauma.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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