June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Endophthalmitis caused by nontuberculous Mycobacteria
Author Affiliations & Notes
  • Milan Shah
    Midwest Eye Institute, Indianapolis, IN
  • Nidhi Batra
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • Ajay E Kuriyan
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • D. Wilkin Parke
    VitreoRetinal Surgery, PA, Minneapolis, MN
  • Janet L Davis
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • Darlene Miller
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • Harry W Flynn
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • Thomas Arno Albini
    Bascom Palmer Eye Institute, Univ of Miami/Miller School of Medicine, Miami, FL
  • Footnotes
    Commercial Relationships Milan Shah, None; Nidhi Batra, None; Ajay Kuriyan, None; D. Wilkin Parke, None; Janet Davis, None; Darlene Miller, None; Harry Flynn, None; Thomas Albini, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4185. doi:
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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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      © ARVO (1962-2015); The Authors (2016-present)

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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

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