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Diabetic, Hypertensive, CAD, Severe LV Dysfunction, Regular Dialysis, Eye Infection, Ophthalmologist, Puss Removed, Culture And Sensitivity Test

Posted on Wed, 23 May 2012

Question: Hello Doctor, my father, 59yrs old, a known diabetic and hypertensive with CAD and severe LV dysfunction on regular dialysis.
Recently he has got eye infection. We have consulted opthalmologist and he has removed the puss and sent it for culture and sensitivity test. Reports says the following:
Nature of Specimen : Vitreous and AC Tap
KOH (Vitreous and AC Tap): No Organisms seen.
Gram Stain (Vitreous and AC Tap): Polymorphs plenty/HPF, Gram negative bacilli 0-5/HPF, Gram positive cocci in pairs 0-1/HPF seen.
Culture : Klebsiella species.
Antibiotic Susceptability:
Senstive :
Amikacin
Ciprofloxacin
Ofloxacin
Gatifloxacin
Moxifloxacin
Ceftazidime
Co Trimoxazole
Chloramphenicol

Please suggest if this infection can be cured using antibiotics or it needs surgery.
Earlier before the report opthamologist has removed the puss and mentioned the risk of eviscerutum.
We have consulted diabetologist for his sugar levels control.
He has seen the report and advised the following medicines:
Monocef 2gm Inj IV - OD
T. zanocin 200 - (8am -8pm)

Please advice if this infection can be cured using medicines or does it needs surgery. Can he get back his vision?

Answered by Dr. Dr. Rakhi Tayal (3 hours later)

Hello,

Thanks for writing to us.

The pus culture and sensitivity report says the organism klebsiella is sensitive to all the commonly used antibiotics. Your diabetologist has chosen good antibiotics for your father considering his heart and kidney status. According to the report, if diabetes remains well under control, these antibiotics should give a good response and should control the infection well. The only thing to be taken care of is to take the full course of medicine well in time as prescribed by your physician.

The extent of recovery of eyesight cannot be judged without examining the patient. The treating ophthalmologist is the best person to tell you the prognosis. In my opinion, it seems that he might not need evisceration of eye just because of infection. If he gets the antibiotics properly and keeps blood sugar levels under control, he has good chances of recovery.

I hope this information has been both informative and helpful for you. If there are additional concerns, I am available for your followups.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (10 hours later)

Dear Dr XXXXXXX

Thank you for your prompt response.
Today we have met the opthamalogist.
He has mentioned like panopthalmin.
Please help us in knowing the following:
1. Any treatment available for this case
2. If surgery is the only option, then any chance of removing the infection
instead of evisceration.
3. Any advanced technology to remove the infection

Thank you in advance Doctor

Regards,
Vamsi

Answered by Dr. Dr. Rakhi Tayal (7 hours later)

Hello,

Thanks for writing back.

Panophthalmitis means infection of whole of the eye - its each and every tissue. In such cases even if the eye is saved, the scarring after infection is so bad that you cannot think of restoration of vision.
Broad spectrum antibiotics are the only treatment. If the infection does not subside, removal of the infected tissue is the only option to prevent further spread of infection and other complications.

Sincerely hope it will help.

Wishing you an early recovery.

Above answer was peer-reviewed by : Dr. Raju A.T