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. 2017 May;65(5):371-375.
doi: 10.4103/ijo.IJO_564_16.

Nocardia infection following intraocular surgery: Report of seven cases from a tertiary eye hospital

Devesh Sharma  1 , Umang Mathur  1 , Abha Gour  1 , Manisha Acharya  1 , Nidhi Gupta  1 , Neelam Sapra  1
Affiliations

Nocardia infection following intraocular surgery: Report of seven cases from a tertiary eye hospital

Devesh Sharma et al. Indian J Ophthalmol. 2017 May.

Abstract

Purpose: To study the outcome of ocular nocardiosis following intraocular surgery.

Materials and methods: 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.

Results: 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.

Conclusion: Early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Deep corneal stromal infiltrates at the surgical incision sites in case 3 (a). (b) Following corneal patch grafts
Figure 2
Figure 2
Exudation in the anterior chamber in case 2. B-scan ultrasonography showed involvement of the vitreous cavity
Figure 3
Figure 3
Multiple scleral nodules in case 7. Fundus evaluation revealed an associated exudative retinal detachment
Figure 4
Figure 4
Smears on potassium hydroxide media revealing Nocardia organisms (×2) (a). Nocardia colonies on blood agar (b)
Figure 5
Figure 5
Multiple deep infiltrates and corneal perforation (a) in case 6. (b) Anterior chamber exudation. (c) Following therapeutic penetrating keratoplasty
Figure 6
Figure 6
Scleral patch graft (a) for a scleral abscess in case 1. Three months postoperatively, the eye is quiet (b)
Figure 7
Figure 7
Endoexudate at the corneal surgical incision in case 5 (a). Following a corneal patch graft (b)
See this image and copyright information in PMC

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