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Sandrine Anne Zweifel, Pascal W. Hasler, Peter Maloca, Daniel Barthelmes, Reinhard Rüesch, Christian Böni; Multimodal imaging of choroidal lesions in disseminated Mycobacterium chimaera infection. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1859.
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Recently, M. chimaera, a non-tuberculous mycobacterium, has attracted attention due to a health-care associated outbreak of invasive infections after cardiothoracic surgery. Ocular and histopathologic findings associated with this new disease entity have just been reported. The purpose of this study was to explore morphologic characteristics of choroidal lesions in disseminated M.chimaera infection using multimodal imaging and to propose a classification system into active and inactive forms.
Ophthalmologic imaging findings of nine patients (18 eyes) with confirmed systemic M. chimaera infection were reviewed at baseline and follow-up visits and correlated with the status of the systemic disease control. Enhanced depth imaging optical coherence tomography (EDI OCT) scans over the choroidal lesions were evaluated regarding full/partial thickness, shape, reflectivity, internal pattern, margins and hypertransmission. In addition the lesions were evaluated as active/inactive by biomicroscopy, by fundus autofluorescence imaging, by fluorescein/indocyanine green angiography (ICG) and OCT angiography.
The mean age of the 9 patients (18 eyes) was 54 years. All patients were male presenting with bilateral choroidal lesions of varying extent. The mean follow-up time was 14.9 months. Based on color photographs alone the degree of activity of the lesion could not always be assessed and some clinically silent choroidal lesions were missed, but were revealed using ICG and/or OCT. The lesions were hyopfluorescent in ICG and appeared in the earlier phases. The subfoveal choroidal thickness (SFCT) was not increased (mean 255 um; standard deviation +/- 63 um). Active choroidal lesions were more likely to be full-thickness, round shaped, hyporeflective with well-defined borders.
Choroidal manifestations in patients with disseminated M. chimaera infection are good and easy accessible indicators of systemic disease control. Monitoring of disease activity in these patients cannot be based on color fundus photography only. SFCT does not seem to be a valable monitoring criterion neither. EDI OCT in combination with ICG is suitable to visualize choroidal lesions, to classifiy them as active or inactive, to assess the response to antimicrobial treatment and to detect early subclinical recurrences.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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