Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Infection and Tropical Medicine, Tri-Service General Hospital, Taipei, Taiwan.
Eye (Lond). 2018 Sep;32(9):1504-1511. doi: 10.1038/s41433-018-0108-1. Epub 2018 May 29.
To report the clinical features and treatment outcomes in a cluster of patients with endophthalmitis after cataract surgery caused by nontuberculous mycobacterium.
Retrospective chart review and noncomparative, consecutive case series. Nine consecutive cases of endophthalmitis, after cataract surgery in a local clinic, were referred to our hospital. The treatment outcomes and analysis of risk factors for infection are reported.
The major symptoms at presentation were pain, redness, and decreased vision. Best-corrected visual acuity at presentation ranged from hand motion in two cases (22%), counting fingers at 30 cm in three cases (33%), 20/100 in two cases (20%), 20/63 in one case (11%), to 20/50 in one (11%) case. The mean duration between cataract surgery to presentation at our hospital was 16.7 days. Prompt intravitreal injections (IVI) of amikacin (0.4 mg/0.1 mL) and vancomycin (1 mg/0.1 mL), with topical moxifloxacin were administered initially. Pars plana vitrectomy with amikacin (10 mg/L) and vancomycin (20 mg/L) intravitreal irrigation, and intraocular lens removal were performed for all patients. Systemic antibiotics including amikacin and tigecycline were prescribed for 10 days, and clarithromycin was prescribed for at least 3 months. In all the nine cases, the culture results from either aqueous tapping or vitrectomy sample were positive for nontuberculous Mycobacterium: Mycobacterium abscessus/chelonae, which was compatible with iatrogenic clustered infection. At the last follow-up, three cases (33.3%) had best-corrected visual acuity of counting fingers at 30 cm, while the other six cases had no light perception. Two cases (22%) were enucleated and one case (11%) had phthisis bulbi.
Nontuberculous mycobacterium endophthalmitis (NTME) often induces chronic recurrent or persistent intraocular inflammation. Very poor outcomes despite aggressive antibiotic treatment and repeated surgical interventions are suggestive of the virulent nature of the organisms. Autoclave sterilization and perioperative disinfection may help in reducing iatrogenic clustered infection.
报告一组由非结核分枝杆菌引起的白内障术后眼内炎患者的临床特征和治疗结果。
回顾性图表回顾和非对照、连续病例系列。9 例白内障术后眼内炎患者在当地诊所就诊后被转至我院。报告了治疗结果和感染危险因素分析。
主要症状为疼痛、眼红和视力下降。就诊时最佳矫正视力从 2 例（22%）手动，3 例（33%）数指于 30cm，2 例（20%）20/100，1 例（11%）20/63，1 例（11%）20/50。白内障手术后至我院就诊的平均时间为 16.7 天。最初给予玻璃体腔内注射阿米卡星（0.4mg/0.1mL）和万古霉素（1mg/0.1mL），并局部滴用莫西沙星。所有患者均行玻璃体切割术，并用阿米卡星（10mg/L）和万古霉素（20mg/L）行玻璃体腔内灌洗，并取出眼内晶状体。所有患者均给予阿米卡星和替加环素全身抗生素治疗 10 天，并至少给予克拉霉素治疗 3 个月。9 例患者的眼内液或玻璃体样本培养结果均为非结核分枝杆菌阳性：脓肿分枝杆菌/龟分枝杆菌，符合医源性聚集性感染。末次随访时，3 例（33.3%）最佳矫正视力为 30cm 数指，6 例（66.7%）无光感。2 例（22%）眼球摘除，1 例（11%）眼球萎缩。
非结核分枝杆菌眼内炎（NTME）常引起慢性复发性或持续性眼内炎症。尽管采用积极的抗生素治疗和反复手术干预，预后仍很差，提示病原体具有很强的毒性。高压灭菌和围手术期消毒有助于减少医源性聚集性感染。
