Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis

 Klin Monatsbl Augenheilkd. 1998 Dec;213,6:351-4. Pars plana vitrectomy in Borrelia
burgdorferi endophthalmitis [Article in German] Meier P, Blatz R, Gau M, Spencker FB, 
Wiedemann P.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig.
BACKGROUND: Ocular manifestations of Lyme borreliose present with unusual forms of 
conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis. CASE 
REPORT: A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an 
endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light 
perception and hand motions. The slit-lamp examination revealed severe inflammation of the 
anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. 
Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was 
performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. 
Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and 
54endophthalmitis developed when antibiotic therapy was finished. RESULTS: During pars plana
vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy 
yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate 
structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 
1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal 
vasculitis in the follow up of 6 months. CONCLUSIONS: Despite intravenous 
ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further 
investigations are required with respect to the use of other antibiotics or immunosuppressives

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