Delayed Staphylococcus warneri endophthalmitis in a pediatric marfan patient after scleral-sutured intraocular lens implantation.

Pediatric endophthalmitis is a rare but vision-threatening condition, most commonly associated with trauma worldwide. A case of delayed-onset postoperative Staphylococcus warneri endophthalmitis was identified in a 7-year-old boy with Marfan syndrome after scleral-sutured Akreos AO60 intraocular lens (IOL) implantation. After lensectomy, pars plana vitrectomy, and Gore-Tex-fixated IOL placement with intraoperative moxifloxacin, early postoperative examinations were unremarkable. At postoperative day 59, the patient developed progressive vision loss with white, spherical deposits coating the IOL and hazy fundus view. Despite initially mild inflammation treated with topical corticosteroids, the condition progressed to anterior chamber inflammation with biofilm-like refractile deposits involving the IOL and scleral sutures, prompting vitreous tap, intravitreal vancomycin and ceftazidime, and membrane peeling. Cultures grew rare S. warneri. After transient improvement, recurrent endophthalmitis with vitritis necessitated vitrectomy with IOL and Gore-Tex suture explantation and adjunctive systemic antibiotics. The patient underwent repeat scleral-sutured IOL implantation 4 months later, and best-corrected visual acuity improved to 20/40, with no apparent recurrence of endophthalmitis at 6 months following explantation of the initial scleral-sutured IOL.