Abstract
Purpose :
This work describes the clinical presentation, the diagnostic challenges, and current treatment modalities of non-tuberculosis Mycobacterial endophthalmitis (NTME), a rare, yet devastating complication of intra-ocular surgery.
Methods :
This study is a retrospective, noncomparative case series of three patients, from two different institutions, who were diagnosed with culture-proven Mycobacterium chelonae endophthalmitis secondary to glaucoma tube shunt exposure. The literature on glaucoma drainage implants and NTME was likewise reviewed from 2000 to 2023 with identification of 12 comparable case reports.
Results :
We describe three patients with chronically immunosuppressed eyes who developed non-tuberculosis Mycobacterial endophthalmitis after Baerveldt tube shunt exposure. Visual acuity was hand-motion in two of three patients who notably lacked pain on presentation. Corneal transplant rejection and anterior uveitis flares were differential considerations amongst these patients. Empiric therapy was initiated after patients developed worsening vitritis, dense vitreous strands or hypopyon with an overall mean time to positive culture of 9 days. The time to diagnosis and definitive therapy are summarized in Table 1. Despite culture-sensitivity to intravitreal amikacin and device removal, visual prognosis was poor with two patients progressing to light perception and no light perception vision.
Twelve additional cases of tube shunt related NTME were identified by literature review. Results of this case series were comparable with published reports with a predominance of M. chelonae sub-species. NTME represents a tenacious infection across studies – sometimes requiring upwards of 20 injections to eradicate the infection. Devices in our case series yielded positive culture results up to 48 days after explantation. Removal of biofilms and implanted devices remains the essence of definitive source control in addition to local and systemic antimicrobial coverage. The three primary cases and the twelve cases from literature review are summarized in Table 2.
Conclusions :
Overall, this work highlights the challenging clinical course of patients with non-tuberculosis Mycobacterial endophthalmitis and the need for multi-subspecialty ophthalmic care. Patients often require aggressive surgical and medical approaches to reach quiescence with often guarded visual outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.