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Chronic Nocardia asteroides endophthalmitis after extracapsular cataract extraction
P L Zimmerman1, N Mamalis, J B Alder
1Department of Ophthalmology, University of Utah, Salt Lake City.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 1, 1993
Summary
A rare case of chronic endophthalmitis caused by Nocardia asteroides occurred after cataract surgery. Despite extensive treatment, the infection led to globe enucleation, highlighting a challenging complication.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Cataract surgery, specifically extracapsular extraction with intraocular lens (IOL) placement, is a common procedure.
- Endophthalmitis is a serious intraocular infection that can lead to vision loss.
Observation:
- A 65-year-old male developed delayed-onset chronic endophthalmitis following uncomplicated cataract surgery.
- The causative agent was identified as Nocardia asteroides through intraocular cultures and histopathology of the lens capsular bag.
Findings:
- The patient received aggressive treatment including antibiotics (periocular, intravitreal, systemic), IOL removal, capsulectomy, and multiple vitrectomies.
- Despite comprehensive management, the infection progressed to widespread endophthalmitis, necessitating enucleation of the affected eye.
Implications:
- This case represents the first documented instance of delayed-onset chronic endophthalmitis caused by Nocardia asteroides post-extracapsular cataract extraction with posterior chamber IOL.
- Highlights the importance of considering unusual pathogens in chronic post-operative endophthalmitis and the potential for severe outcomes even with prompt, aggressive treatment.