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Milan Shah, Nidhi Batra, Ajay E Kuriyan, D. Wilkin Parke, Janet L Davis, Darlene Miller, Harry W Flynn, Thomas Arno Albini; Endophthalmitis caused by nontuberculous Mycobacteria. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4185.
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To report on the clinical presentation, antibiotic susceptibilities and clinical outcomes on a series of endophthalmitis caused by nontuberculous Mycobacteria.
A single-center study evaluating all cases of culture- positive endophthalmitis confirmed to be due to nontuberculous mycobacteria between December 1990 and June 2014 at a large university, referral center. The corresponding clinical records of these culture positive patients were then reviewed for evaluation of the clinical features, therapeutic intervention and outcomes.
Seventeen patients were confirmed to have nontuberculous Mycobacterial endophthalmitis. Sixteen of the 17 cases were related to a previous ocular surgery or intravitreal injection. The clinical setting of endophthalmitis was comprised as follows: post-cataract surgery (6 pts, 34% ), glaucoma drainage implant exposure (4 pts, 24%), post-intravitreal injection (2 pts, 12%), post IOL-exchange (1 pt, 6%), post-pupilloplasty (1 pt, 6%), post -pars plana vitrectomy (1 pt, 6%), exposed scleral buckle (1 pt, 6%) and endogenous endophthalmitis (1 pt, 6%). Four out of 6 (66%) patients with endophthalmitis related to cataract surgery, had removal of the intraocular lens. All four patients (100%) with endophthalmitis related to glaucoma tube shunts necessitated removal of the implant. Fifteen (88%) patients received intraocular antibiotic treatment; 4 pts received intravitreal ceftazadime/vancomycin, 10 pts received intravitreal amikacin and 1 pt received intracameral amikacin. One patient was treated with subconjunctival and parenteral antibiotics. The one patient with endogenous disease was treated with a combination of systemic antibiotics. Final best corrected visual acuity (BCVA) was variable; BCVA 20/40 was achieved in 3 (18%) of the patients, <20/40 ≥20/400 in 6 (35%) patients, <20/400 in 6 (35%) patients and 2 (12%) patients underwent enucleation. Of those isolates that underwent susceptibility testing, 12 of 16 (75%) and 13 of 15 (87%) were found to be sensitive to clarithromycin and amikacin, respectively.
Endophthalmitis caused by nontuberculous mycobacteria is generally associated with a poor visual outcome. Most cases are due to inoculation during ocular surgery or intraocular injection. Repetitive treatment with intravitreal injections is often required to eradicate the infection
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