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

Surgical Management of a Large Klebsiella pneumoniae Subretinal Abscess Secondary to Liver Abscess: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Surgical Management of a Large Klebsiella pneumoniae Subretinal Abscess Secondary to Liver Abscess: A Case Report Cuicui Tang, Zhihui Jiang, Xiaojia Hu, Lianghong Peng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8636690/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Subretinal abscess Endogenous endophthalmitis Klebsiella pneumoniae Liver abscess Pars plana vitrectomy Figures Figure 1 Background Endogenous endophthalmitis (EE) is a rare but severe intraocular infection resulting from the hematogenous spread of microorganisms from a distant infectious source. In East Asia, Klebsiella pneumoniae is the most common pathogen, frequently associated with EE secondary to liver abscesses. The formation of a subretinal abscess (SRA) is an uncommon complication of EE, occurring in approximately 6.5% of cases, and typically signifies a more advanced and severe infection. SRAs carry a poor prognosis. If not treated promptly, they can lead to severe vision loss, exudative or rhegmatogenous retinal detachment, and may ultimately necessitate enucleation or evisceration. Case Presentation A 66-year-old man presented with a 2-week history of fever, chills, and progressive vision loss in the right eye. Laboratory findings revealed a white blood cell count of 9.72×10⁹/L, C-reactive protein (CRP) of 90.13 mg/L, and procalcitonin (PCT) of 0.19 ng/mL. Computed tomography (CT) of the chest and abdomen demonstrated a large abscess in the right hepatic lobe. The patient underwent percutaneous drainage of the liver abscess, and culture of the drainage fluid confirmed Klebsiella pneumoniae infection. He was started on oral moxifloxacin. On ophthalmologic examination, the right eye's visual acuity was limited to finger counting at 30 cm, with an intraocular pressure of 8 mmHg. The lens was cloudy (graded C2N2P1), and there was a mild vitreous haze with yellowish-white opacities ("snowball sign") in the inferior vitreous. Fundus examination revealed a yellowish-white SRA approximately 6 optic disc diameters (PD) in size, located in the inferotemporal quadrant and involving the macular region, with an absent foveal reflex (Fig. 1 A). The left eye was unremarkable. The patient underwent PPV of the right eye. Intraoperatively, a grayish-white, edematous retina with surface purulent plaques was noted. The turbid vitreous was completely excised. Given the large size and viscous nature of the SRA, a 1/2 PD retinal incision was made in an avascular area. A 23-gauge flute needle was used to gently dislodge the abscess from the retina and choroid, followed by aspiration with a vitrectomy probe. After the abscess was fully cleared, gas-fluid exchange confirmed retinal reattachment, and the vitreous cavity was filled with silicone oil. Retinal laser photocoagulation was performed around the retinal break on postoperative day 4. Three months later, the patient underwent phacoemulsification with intraocular lens implantation and silicone oil removal. Postoperatively, his right eye visual acuity improved to 20/200, and intraocular pressure was 11 mmHg. Fundus examination revealed a flat retina and an atrophic macular lesion approximately 1.5 PD in size (Fig. 1 B). Discussion The optimal treatment strategy for SRA remains controversial, with no established clinical guidelines. Current literature supports a combination of systemic or intravitreal antibiotics with pars plana vitrectomy (PPV) as the mainstay of therapy. PPV is crucial for removing the infectious load, endotoxins, and vitreoretinal membranes, thereby reducing the risk of retinal detachment. An early study reported that eyes undergoing PPV were three times more likely to preserve vision compared to those managed non-surgically. The specific surgical approach often depends on the abscess size and characteristics. For smaller abscesses (< 4 PD), PPV with intravitreal antibiotics alone may be sufficient. For larger lesions, as in our case, more aggressive intervention is often necessary. Options include retinectomy to excise the abscess or, as we performed, direct drainage through a micro-incision. Eschle-Meniconi et al. proposed tailoring treatment based on lesion infiltration, favoring PPV with biopsy for advanced cases with vitreous involvement. While internal drainage of an SRA carries a risk of precipitating complex retinal detachment from vitreoretinal proliferation, it is sometimes necessary when standard treatments are insufficient or the abscess is too large and viscous for antibiotics to penetrate effectively. In this patient, the large size (6 PD) and dense consistency of the abscess warranted direct evacuation to debulk the infection and facilitate recovery. The use of a small retinal incision minimized trauma, and subsequent laser and silicone oil tamponade successfully prevented retinal detachment, leading to a favorable anatomical and functional outcome. Conclusion Direct surgical evacuation of a large Klebsiella pneumoniae subretinal abscess via PPV and retinal micro-incision can be an effective strategy for salvaging the globe and preserving useful vision. This case supports an aggressive surgical approach in severe presentations of EE with large, organized SRAs. Declarations Ethics approval and consent to participate: This study was conducted in accordance with the tenets of the Declaration of Helsinki. Institutional review board approval was not required for this case report. Consent for publication: Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution CT drafted the manuscript. ZJ conducted pathogen detection and guided the formulation of drug treatment regimens. XH collected the clinical data. LP performed the surgery, designed the treatment plan, and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. Acknowledgements: We thank the patient for providing permission to publish his information. Availability of data and materials: Not applicable. References Grzybowski A, Turczynowska M, Schwartz SG, Relhan N, Flynn HW Jr. The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis (2020) A Review and an International Perspective. Ophthalmol Ther 9(3):485–498 Lim SW, Sung Y, Kwon HJ, Song WK (2020) Endogenous Endophthalmitis Associated with Liver Abscess Successfully Treated with Vitrectomy and Intravitreal Empirical Antibiotics Injections. Case Rep Ophthalmol Med 2020:8165216 Zafar S, Siddiqui MAR (2018) Sub-retinal abscess as presenting feature of endogenous Candida endophthalmitis. BMC Res Notes 11(1):598 Eschle-Meniconi ME, Guex-Crosier Y, Wolfensberger TJ (2011) Endogenous ocular nocardiosis: an interventional case report with a review of the literature. Surv Ophthalmol 56(5):383–415 Jackson TL, Eykyn SJ, Graham EM, Stanford MR (2003) Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 48(4):403–423 Tsai TH, Peng KL (2005) Metastatic endophthalmitis combined with subretinal abscess. Kaohsiung J Med Sci 21(4):185–189 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8636690","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":622110353,"identity":"a1ab0cf9-fd69-42bb-8e87-edefb0b2eea7","order_by":0,"name":"Cuicui Tang","email":"","orcid":"","institution":"General Hospital of Southern Theatre Command","correspondingAuthor":false,"prefix":"","firstName":"Cuicui","middleName":"","lastName":"Tang","suffix":""},{"id":622110354,"identity":"f53adabe-8bd4-48e8-8160-49c40a6ff266","order_by":1,"name":"Zhihui Jiang","email":"","orcid":"","institution":"General Hospital of Southern Theatre Command","correspondingAuthor":false,"prefix":"","firstName":"Zhihui","middleName":"","lastName":"Jiang","suffix":""},{"id":622110355,"identity":"894d6e81-80c6-4815-9647-66c1c5272c88","order_by":2,"name":"Xiaojia Hu","email":"","orcid":"","institution":"General Hospital of Southern Theatre Command","correspondingAuthor":false,"prefix":"","firstName":"Xiaojia","middleName":"","lastName":"Hu","suffix":""},{"id":622110356,"identity":"4a99878a-b078-401c-b0a4-48f11735c0d8","order_by":3,"name":"Lianghong Peng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYFACHgjFz8x8+AFpWiTb2dIMSNNicJ5HQYIoDeb8Zw8++FFhl2d8mIfBgKHGJpqgFsuGc8mGPWeSi80O8x54wHAsLbeBkBaDgz1m0oxtzInbDvMlGDA2HCZCy2EeoJZ/9Ymbm3kMJIjTcgykpeFw4gZmYrVY9vAYG/YcO5444zAwkBOI8Ys5/xnDBz9qqhP7+w8ffvChxoYIh6HwEggpx9QyCkbBKBgFowAbAAA74jv/i16oOgAAAABJRU5ErkJggg==","orcid":"","institution":"General Hospital of Southern Theatre Command","correspondingAuthor":true,"prefix":"","firstName":"Lianghong","middleName":"","lastName":"Peng","suffix":""}],"badges":[],"createdAt":"2026-01-19 08:37:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8636690/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8636690/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106901531,"identity":"29025b19-1bde-4109-aa42-e691da780950","added_by":"auto","created_at":"2026-04-14 15:03:19","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":373264,"visible":true,"origin":"","legend":"\u003cp\u003eFundus photography of the right eye. (A) At initial presentation, showing a large, yellowish-white subretinal abscess approximately 6 disc diameters in size, involving the macula. Note the mild vitreous haze. (B) Three months post-operatively, after PPV, abscess evacuation, and silicone oil removal, showing a flat retina with an atrophic scar in the macular region.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8636690/v1/b4e8111e41ecac9d7fd954e2.jpeg"},{"id":106961241,"identity":"eb410646-251e-4ad9-87c9-d6c80f497efb","added_by":"auto","created_at":"2026-04-15 09:24:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":726570,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8636690/v1/51299fb1-dd5f-4562-91a1-5cbda6797b4e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Surgical Management of a Large Klebsiella pneumoniae Subretinal Abscess Secondary to Liver Abscess: A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eEndogenous endophthalmitis (EE) is a rare but severe intraocular infection resulting from the hematogenous spread of microorganisms from a distant infectious source. In East Asia, Klebsiella pneumoniae is the most common pathogen, frequently associated with EE secondary to liver abscesses. The formation of a subretinal abscess (SRA) is an uncommon complication of EE, occurring in approximately 6.5% of cases, and typically signifies a more advanced and severe infection. SRAs carry a poor prognosis. If not treated promptly, they can lead to severe vision loss, exudative or rhegmatogenous retinal detachment, and may ultimately necessitate enucleation or evisceration.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 66-year-old man presented with a 2-week history of fever, chills, and progressive vision loss in the right eye. Laboratory findings revealed a white blood cell count of 9.72\u0026times;10⁹/L, C-reactive protein (CRP) of 90.13 mg/L, and procalcitonin (PCT) of 0.19 ng/mL. Computed tomography (CT) of the chest and abdomen demonstrated a large abscess in the right hepatic lobe. The patient underwent percutaneous drainage of the liver abscess, and culture of the drainage fluid confirmed Klebsiella pneumoniae infection. He was started on oral moxifloxacin.\u003c/p\u003e \u003cp\u003eOn ophthalmologic examination, the right eye's visual acuity was limited to finger counting at 30 cm, with an intraocular pressure of 8 mmHg. The lens was cloudy (graded C2N2P1), and there was a mild vitreous haze with yellowish-white opacities (\"snowball sign\") in the inferior vitreous. Fundus examination revealed a yellowish-white SRA approximately 6 optic disc diameters (PD) in size, located in the inferotemporal quadrant and involving the macular region, with an absent foveal reflex (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The left eye was unremarkable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient underwent PPV of the right eye. Intraoperatively, a grayish-white, edematous retina with surface purulent plaques was noted. The turbid vitreous was completely excised. Given the large size and viscous nature of the SRA, a 1/2 PD retinal incision was made in an avascular area. A 23-gauge flute needle was used to gently dislodge the abscess from the retina and choroid, followed by aspiration with a vitrectomy probe. After the abscess was fully cleared, gas-fluid exchange confirmed retinal reattachment, and the vitreous cavity was filled with silicone oil. Retinal laser photocoagulation was performed around the retinal break on postoperative day 4.\u003c/p\u003e \u003cp\u003eThree months later, the patient underwent phacoemulsification with intraocular lens implantation and silicone oil removal. Postoperatively, his right eye visual acuity improved to 20/200, and intraocular pressure was 11 mmHg. Fundus examination revealed a flat retina and an atrophic macular lesion approximately 1.5 PD in size (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe optimal treatment strategy for SRA remains controversial, with no established clinical guidelines. Current literature supports a combination of systemic or intravitreal antibiotics with pars plana vitrectomy (PPV) as the mainstay of therapy. PPV is crucial for removing the infectious load, endotoxins, and vitreoretinal membranes, thereby reducing the risk of retinal detachment. An early study reported that eyes undergoing PPV were three times more likely to preserve vision compared to those managed non-surgically.\u003c/p\u003e \u003cp\u003eThe specific surgical approach often depends on the abscess size and characteristics. For smaller abscesses (\u0026lt;\u0026thinsp;4 PD), PPV with intravitreal antibiotics alone may be sufficient. For larger lesions, as in our case, more aggressive intervention is often necessary. Options include retinectomy to excise the abscess or, as we performed, direct drainage through a micro-incision. Eschle-Meniconi et al. proposed tailoring treatment based on lesion infiltration, favoring PPV with biopsy for advanced cases with vitreous involvement.\u003c/p\u003e \u003cp\u003eWhile internal drainage of an SRA carries a risk of precipitating complex retinal detachment from vitreoretinal proliferation, it is sometimes necessary when standard treatments are insufficient or the abscess is too large and viscous for antibiotics to penetrate effectively. In this patient, the large size (6 PD) and dense consistency of the abscess warranted direct evacuation to debulk the infection and facilitate recovery. The use of a small retinal incision minimized trauma, and subsequent laser and silicone oil tamponade successfully prevented retinal detachment, leading to a favorable anatomical and functional outcome.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDirect surgical evacuation of a large Klebsiella pneumoniae subretinal abscess via PPV and retinal micro-incision can be an effective strategy for salvaging the globe and preserving useful vision. This case supports an aggressive surgical approach in severe presentations of EE with large, organized SRAs.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e \u003cp\u003eThis study was conducted in accordance with the tenets of the Declaration of Helsinki. Institutional review board approval was not required for this case report.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCT drafted the manuscript. ZJ conducted pathogen detection and guided the formulation of drug treatment regimens. XH collected the clinical data. LP performed the surgery, designed the treatment plan, and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003e We thank the patient for providing permission to publish his information.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGrzybowski A, Turczynowska M, Schwartz SG, Relhan N, Flynn HW Jr. The Role of\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSystemic Antimicrobials in the Treatment of Endophthalmitis (2020) A Review and an International Perspective. Ophthalmol Ther 9(3):485\u0026ndash;498\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim SW, Sung Y, Kwon HJ, Song WK (2020) Endogenous Endophthalmitis Associated with Liver Abscess Successfully Treated with Vitrectomy and Intravitreal Empirical Antibiotics Injections. Case Rep Ophthalmol Med 2020:8165216\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZafar S, Siddiqui MAR (2018) Sub-retinal abscess as presenting feature of endogenous Candida endophthalmitis. BMC Res Notes 11(1):598\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEschle-Meniconi ME, Guex-Crosier Y, Wolfensberger TJ (2011) Endogenous ocular nocardiosis: an interventional case report with a review of the literature. Surv Ophthalmol 56(5):383\u0026ndash;415\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJackson TL, Eykyn SJ, Graham EM, Stanford MR (2003) Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 48(4):403\u0026ndash;423\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai TH, Peng KL (2005) Metastatic endophthalmitis combined with subretinal abscess. Kaohsiung J Med Sci 21(4):185\u0026ndash;189\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Subretinal abscess, Endogenous endophthalmitis, Klebsiella pneumoniae, Liver abscess, Pars plana vitrectomy","lastPublishedDoi":"10.21203/rs.3.rs-8636690/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8636690/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo report the successful surgical management of a large, vision-threatening subretinal abscess (SRA) secondary to endogenous \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e endophthalmitis.\u003c/p\u003e\u003ch2\u003eCase Presentation:\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e\u003ch2\u003eIntervention:\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePostoperatively, 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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDirect 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.\u003c/p\u003e","manuscriptTitle":"Surgical Management of a Large Klebsiella pneumoniae Subretinal Abscess Secondary to Liver Abscess: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 15:03:15","doi":"10.21203/rs.3.rs-8636690/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c7616d13-b54b-4893-86ba-032d0eba34f0","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T15:03:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 15:03:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8636690","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8636690","identity":"rs-8636690","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}