Asian Journal of Case Reports in Surgery

Background: Postoperative infectious keratitis is an uncommon but vision-threatening complication of cataract surgery that may rapidly progress to corneal perforation, endophthalmitis, and irreversible visual loss. Although intensive fortified topical antibiotics remain the standard treatment, their penetration into the deep corneal stroma may be insufficient in severe infections. We report a case of a refractory postoperative corneal abscess that was successfully treated with repeated subconjunctival vancomycin and ceftazidime injections, thereby avoiding evisceration.

Case Presentation: A 58-year-old man presented five days after extracapsular cataract extraction with severe ocular pain, redness, photophobia, tearing, and profound visual impairment of the left eye. Slit-lamp examination revealed a 4 × 3 mm superior corneolimbal abscess involving the surgical sutures, associated with a matching epithelial defect, diffuse conjunctival hyperaemia, stromal oedema, and folds in Descemet's membrane. Corneal scraping performed before initiation of antimicrobial therapy yielded negative culture results. The patient received intensive fortified topical vancomycin and ceftazidime; however, clinical deterioration occurred, resulting in wound dehiscence that required surgical resuturing. Because of the poor response to treatment and the high risk of evisceration, repeated subconjunctival injections of vancomycin (1 mg) and ceftazidime (2.25 mg) were initiated while maintaining intensive topical therapy. Four injections were administered according to the clinical response, leading to the progressive regression of stromal infiltration, conjunctival inflammation, and the epithelial defect. Complete corneal re-epithelialisation was achieved within three weeks, with preservation of the globe and no recurrence of infection during follow-up.

Conclusion: Repeated subconjunctival administration of vancomycin and ceftazidime may represent an effective globe-preserving adjunctive therapy for severe postoperative corneal abscesses refractory to conventional topical treatment. This therapeutic combination has rarely been reported in the literature and warrants further investigation to establish standardised indications and treatment protocols.