Surgical Management of a Large Klebsiella pneumoniae Subretinal Abscess Secondary to Liver Abscess: A Case Report

Purpose To report the successful surgical management of a large, vision-threatening subretinal abscess (SRA) secondary to endogenous Klebsiella pneumoniae endophthalmitis. Case Presentation: A 66-year-old man presented with fever and progressive vision loss in his right eye. He was diagnosed with a Klebsiella pneumoniae liver abscess, which was managed with percutaneous drainage and systemic antibiotics. Ophthalmic examination revealed visual acuity of finger counting at 30 cm, mild vitreous haze, and a large (approximately 6 disc diameters) yellowish-white SRA involving the macula. Intervention: The patient underwent 23-gauge pars plana vitrectomy (PPV). Due to the viscous nature of the abscess, a retinal micro-incision was created, and the purulent material was meticulously evacuated using a flute needle and vitrectomy probe. The procedure was completed with retinal laser photocoagulation and silicone oil tamponade. The silicone oil was removed three months later combined with phacoemulsification. Results Postoperatively, the retina remained attached. Final best-corrected visual acuity in the right eye improved to 20/200. Fundus examination showed a flat retina with an atrophic macular scar. Conclusion Direct surgical evacuation via PPV with retinal micro-incision is an effective strategy for managing large SRAs in endogenous endophthalmitis. This approach can clear the infectious nidus, prevent retinal detachment, and preserve useful vision in severe cases.