Management of post-operative Nocardia endophthalmitis

Abstract

Post-operative Nocardia endophthalmitis has an aggressive course and poor visual prognosis. It often masquerades as severe post-operative uveitis or toxic anterior segment syndrome due to the absence of vitreous involvement resulting in a delay in diagnosis. The poor prognosis in Nocardia endophthalmitis is due to severe intra-ocular inflammation which may lead to phthisis. Therefore, treatment with corticosteroids after appropriate antibiotics have been initiated may improve the outcome. This is an interventional case report highlighting the typical features of Nocardia endophthalmitis, which when diagnosed early and managed medically with antibiotics and steroids, resulted in an excellent visual outcome in our patient.

Nocardia keratitis presenting as an anterior chamber ball of exudates and its management

“…Orally administered sulfamethoxazole/trimethoprim is known to attain therapeutic levels in the aqueous and vitreous cavity in a non-inflamed human eye 26. Although systemic antibiotics have been used in treatment of N. endophthalmitis,27–29 its role in keratitis is not very clear 6. In this patient, however, the resolution of exudates in the AC only occurred after commencement of sulfamethoxazole/trimethoprim (800 mg/160 mg).…”

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

“…[ 6 ] However, encouraging results have been noted in isolated case reports. [ 7 8 ] The present retrospective analysis was conducted to evaluate the clinical outcomes of Nocardia infections after intraocular surgery.…”

Bleb-Associated Exogenous Nocardia Endophthalmitis

“…Despite favorable in vitro susceptibility profiles, advanced intraocular nocardia infections remain challenging to eradicate owing to abscess formation in the eye and elsewhere, and they are associated with poor ocular outcomes . Early postcataract nocardia endophthalmitis has been successfully treated with combined topical and oral cotrimoxazole but is often difficult to diagnose, mimicking chronic inflammation or fungal infection. Earlier recognition of the characteristic cotton-ball infiltrates may accelerate diagnosis/treatment and improve outcomes.…”