Vivek Pravin Dave1, Avinash Pathengay2, Savitri Sharma3, N Naveen4, Soumyava Basu5, Rajeev R Pappuru6, Taraprasad Das6. 1. Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India. Electronic address: vivekoperates@yahoo.co.in. 2. Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Visakhapatnam, India. 3. Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India. 4. Academy of Eye Care Education, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India. 5. Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India. 6. Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
Abstract
PURPOSE: To describe the clinical presentations, diagnosis, and management outcomes of Nocardia endophthalmitis. DESIGN: Retrospective, interventional, multicenter case series. METHODS: The study was conducted in a multicentric institutional practice setup and included 25 eyes of 25 patients with culture-proven Nocardia endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. Patients with non-Nocardia etiology and those that were culture negative were excluded. Case records were studied and data regarding demography, clinical presentations, interventions received, and final visual and anatomic outcomes were noted. The main outcome measures were final visual outcomes and factors determining them. RESULTS: The mean age of the patients was 54.7 ± 22.9 years. By the etiology of infection, 18 (75%) eyes were post-cataract surgery (operated elsewhere), 3 (12.5%) eyes were posttrauma, and 3 (12.5%) eyes were endogenous. The final follow-up was a mean of 14.25 ± 30.35 months, median 2 months. The odds of a favorable outcome were 42.5 (95% confidence interval [CI] 3.15 to 571.84, P = .0047) when the vision was more than hand motions at presentation, 9.42 (95% CI 0.92 to 95.89, P = .05) in male sex, 21 (95% CI 0.9 to 489.7, P = .05) when presentation was within 48 hours, and 2.5 (95% CI 0.23 to 26.48, P = .44) with primary vitrectomy instead of a biopsy. The in vitro susceptibility was poor for vancomycin and was best for amikacin. CONCLUSIONS: The visual outcome in Nocardia endophthalmitis is very guarded when presenting vision is poor. On diagnostic confirmation or high index of suspicion, intravitreal amikacin is preferred.
PURPOSE: To describe the clinical presentations, diagnosis, and management outcomes of Nocardia endophthalmitis. DESIGN: Retrospective, interventional, multicenter case series. METHODS: The study was conducted in a multicentric institutional practice setup and included 25 eyes of 25 patients with culture-proven Nocardia endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. Patients with non-Nocardia etiology and those that were culture negative were excluded. Case records were studied and data regarding demography, clinical presentations, interventions received, and final visual and anatomic outcomes were noted. The main outcome measures were final visual outcomes and factors determining them. RESULTS: The mean age of the patients was 54.7 ± 22.9 years. By the etiology of infection, 18 (75%) eyes were post-cataract surgery (operated elsewhere), 3 (12.5%) eyes were posttrauma, and 3 (12.5%) eyes were endogenous. The final follow-up was a mean of 14.25 ± 30.35 months, median 2 months. The odds of a favorable outcome were 42.5 (95% confidence interval [CI] 3.15 to 571.84, P = .0047) when the vision was more than hand motions at presentation, 9.42 (95% CI 0.92 to 95.89, P = .05) in male sex, 21 (95% CI 0.9 to 489.7, P = .05) when presentation was within 48 hours, and 2.5 (95% CI 0.23 to 26.48, P = .44) with primary vitrectomy instead of a biopsy. The in vitro susceptibility was poor for vancomycin and was best for amikacin. CONCLUSIONS: The visual outcome in Nocardia endophthalmitis is very guarded when presenting vision is poor. On diagnostic confirmation or high index of suspicion, intravitreal amikacin is preferred.
Authors: Vivek P Dave; Rajeev R Pappuru; Mohammad A Khader; Sayan Basu; Mudit Tyagi; Avinash Pathengay Journal: Indian J Ophthalmol Date: 2020-08 Impact factor: 1.848
Authors: Chang Liu; Lei Zhang; Lili Liu; Ye Wang; Yanhui Cui; Tianwei Liang; Tianming Chen; Yongqiang Jiang; Gang Liu; Li Li Journal: Front Public Health Date: 2022-07-14