Sharma Devesh, Mathur Umang, Gour Abha, Acharya Manisha, Gupta Nidhi, Sapra Neelam
Department of Cornea and Anterior Segment, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
Indian J Ophthalmol. 2017 May;65(5):371-375. doi: 10.4103/ijo.IJO_564_16.
To study the outcome of ocular nocardiosis following intraocular surgery.
A retrospective review of medical records of all postoperative cases of culture proven Nocardia infection over a period of 3 years, from October 2010 to September 2013, was performed. Microbiological analysis was performed for all cases and included smears and cultures. Fortified 2% amikacin eye drops were the mainstay of treatment. Surgical intervention was performed in case of nonresponse to medical therapy or suspected endophthalmitis.
Seven cases of culture proven Nocardia infection were seen. All cases had been operated in a hospital surgical facility. Six followed phacoemulsification, and one followed a secondary intraocular lens implantation. Four patients were part of a cluster infection. The mean duration between the primary surgical procedure and presentation was 16.14 ± 9.82 days. Five patients had infiltrates at the site of the surgical incision. One each had endophthalmitis and panophthalmitis. Six eyes required surgical intervention. Infection was seen to resolve in four eyes. Two eyes went into phthisis, and one was eviscerated. Only two of the six eyes, where in surgical intervention was performed early, obtained a final visual acuity of 20/60.
Early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.
研究眼内手术后眼部诺卡菌病的转归。
对2010年10月至2013年9月3年间所有经培养证实为诺卡菌感染的术后病例的病历进行回顾性分析。对所有病例进行微生物学分析,包括涂片和培养。强化2%阿米卡星滴眼液是主要治疗手段。如对药物治疗无反应或怀疑有眼内炎,则进行手术干预。
共发现7例经培养证实为诺卡菌感染的病例。所有病例均在医院手术设施中进行手术。6例为白内障超声乳化术后,1例为二期人工晶状体植入术后。4例患者为聚集性感染。初次手术与就诊之间的平均时间为16.14±9.82天。5例患者手术切口部位有浸润。各有1例发生眼内炎和全眼球炎。6只眼需要手术干预。4只眼感染得到缓解。2只眼眼球萎缩,1只眼被摘除眼球。在早期进行手术干预的6只眼中,只有2只最终视力达到20/60。
在前房受累之前尽早进行手术干预,可能有助于保持眼球的解剖和功能完整性。