Silva Ruwan A, Young Ryan, Sridhar Jay
*Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; †Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and ‡Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Retina. 2015 Oct;35(10):2137-46. doi: 10.1097/IAE.0000000000000599.
To describe the risk factors, clinical course, ancillary test findings, treatment strategies, and visual outcomes of a series of patients with choroidal abscesses caused by endogenous Nocardia.
This retrospective, consecutive noncomparative case series included all patients with Nocardia ocular infections at 3 tertiary medical centers over the past 20 years.
Five eyes in 5 patients were identified with choroidal abscesses because of Nocardia. All patients were immunocompromised: one suffered from AIDS and four had autoimmune disorders. Three of the 5 patients (60%) underwent systemic evaluation, and in all 3, nonocular nocardiosis was identified. Four patients (80%) underwent diagnostic ophthalmic surgery and received systemic and intravitreal antibiotics. The final patient deferred these interventions. Outcomes at the last follow-up examination were 20/25, 1/200, hand motion at 1 foot, and 2 patients underwent enucleation. Mean follow-up (± standard deviation) was 159 (± 103) days.
Immunosuppression is the most significant risk factor for developing Nocardia choroidal abscesses. Definitive diagnosis generally requires subretinal biopsy, which is also critical to implementing appropriate antibiotic therapy.
描述一系列由内源性诺卡菌引起的脉络膜脓肿患者的危险因素、临床病程、辅助检查结果、治疗策略及视力预后。
这项回顾性、连续性非对照病例系列研究纳入了过去20年中3家三级医疗中心所有患有诺卡菌眼部感染的患者。
5例患者的5只眼被确诊为因诺卡菌引起的脉络膜脓肿。所有患者均存在免疫功能低下：1例患有艾滋病，4例患有自身免疫性疾病。5例患者中有3例（60%）接受了全身评估，且在所有3例中均发现了非眼部诺卡菌病。4例患者（80%）接受了诊断性眼科手术，并接受了全身及玻璃体腔内抗生素治疗。最后1例患者推迟了这些干预措施。最后一次随访检查时的视力结果分别为20/25、1/200、1英尺处手动，2例患者接受了眼球摘除术。平均随访时间（±标准差）为159（±103）天。
免疫抑制是发生诺卡菌脉络膜脓肿的最重要危险因素。明确诊断通常需要进行视网膜下活检，这对实施适当的抗生素治疗也至关重要。
