Propionibacterium endophthalmitis following Molteno tube repositioning

Purpose: We describe an aphakic patient who developed recurrent Propionibacterium acnes endophthalmitis after Molteno tube revision. Patient and Method: The patient presented with a red painful right eye, decreased vision, and a hypopyon. A moderate anterior chamber reaction and mild vitritis were present. Two weeks earlier, the patient had undergone Molteno tube repositioning. A diagnosis of P. acnes endophthalmitis was made after positive culture of anterior chamber needle aspirate. Results: Initially the patient was treated with repeated intraocular vancomycin injections, to which the eye ''responded poorly.'' Temporary clearance of the infection was achieved after placement of the tube in the subconjunctival space. The patient required explantation of the implant to achieve complete resolution of the infection. Conclusion: Tube reinsertion into the anterior chamber resulted in recurrence of the infection. The evaluation of alternative therapies of aqueous tube shunt-related endophthalmitis would require a large case-controlled series of patients.