Panophthalmitis After Penetrating Keratoplasty

To the Editor. —Panophthalmitis is a devastating condition usually associated with penetrating ocular injuries and hematogenous spread during bacteremia, typically in the setting of intravenous drug abuse.Clostridium perfringensandBacillus cereusaccount for the majority of these cases. We report an unusual case of panophthalmitis following penetrating keratoplasty caused by a β-hemolytic streptococcus. Report of a Case. —A 66-year-old man presented with pseudophakic bullous keratopathy of the left eye. Preoperative preparation for penetrating keratoplasty included tobramycin eye drops, povidoneiodine solution (Betadine) placed on the cornea in the operating room, and local preparation with 10% povidone-iodine solution applied to the lids and periocular region. After a 45-minute procedure without manipulation of the vitreous or intraocular lens, subconjunctival injections of tobramycin (40 mg) and dexamethasone phosphate (2 mg) were given, and polymyxin B sulfate-bacitracin zinc (Polysporin) and prednisolone phosphate ointments were instilled. The donor cornea was obtained from a 24-year-old man