Post-operative ocular infection by nontuberculous mycobacteria
Purpose
To report clinical features and outcomes in two cases of nontuberculous mycobacterial (NTM) endophthalmitis and one case of NTM scleral ulcer.
Methods
A retrospective case series conduct in a tertiary referral center in Taipei. All the 3 cases had microbial confirmation of NTM infection after ocular surgery.
Results
Of the two cases with NTM endophthalmitis, case 1 had previous vitrectomy 80 days ago and case 2 had previous cataract extraction 16 days ago before symptoms attack. The incubation period of case 3 with NTM scleral ulcer was 7-month after scleral buckle surgery. Case 1 presented as neovascular glaucoma initially. Whitish profuse pus presented in anterior chamber 10 days after silicon oil removal and culture yileded M. abscessus. Treatment of massive irrigation combined with topical, multiple intravitreous amikacin injection and systemic antibiotics was used. Case 2 received vitrectomy with intraocular lens removal and case 3 had scleral buckle removal as surgical treatment along with topical Amikacin. Final visual outcomes of case 1 and 2 were no-light-perception and 6/60 respectively, despite aggressive management. Visual acuity of case 3 remained 6/10 in 5-year follow-up.
Conclusion
Ocular NTM infection has various initial presentations. It is difficult to diagnose early and visual outcomes are usually devastating even with aggressive treatment, especially in patients with endophthalmitis. For any ocular inflammation with surgical history and poor response to empirical antibiotics, NTM infection should be suspected.
Conflict of interest
No
Author 1
Last name
HUANG
Initials of first name(s)
YH
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
Author 2
Last name
LIN
Initials of first name(s)
PY
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
Author 3
Last name
HWANG
Initials of first name(s)
DK
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
Author 4
Last name
CHEN
Initials of first name(s)
SJ
Department
Taipei Veterans General Hospital
City
Taipei
Country
Taiwan
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