Abstract
Purpose:
To report on the clinical presentation, antibiotic susceptibilities and clinical outcomes on a series of endophthalmitis caused by nontuberculous Mycobacteria.
Methods:
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.
Results:
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.
Conclusions:
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