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This retrospective cohort study investigated patients with cytomegalovirus anterior uveitis (CMV AU) and compared treatment outcomes between regional and systemic antiviral therapies. Treatment modalities included topical (2% ganciclovir [GCV] eye drops or 0.2% GCV eye gel) and systemic (intravenous GCV or oral valganciclovir) groups. The comparison parameters included response rates, time to response, recurrence rates, time to recurrence, and complications. Forty-four patients (54.5% male) with a mean age of 56 ± 9.87 years were enrolled, with 31 eyes in the topical group and 13 eyes in the systemic group. The median response time was significantly slower in the topical group (63 days [IQR 28-112]) compared to the systemic group (28 days [IQR 24-59]) (p = 0.04). Treatment response rates were 87.1% (27/31) in the topical group and 100% (13/13) in the systemic group (p = 0.30), while recurrence rates were 37% (10/27) and 69.2% (9/13) (p = 0.056), with a median time to recurrence of 483 days [IQR 145-1388] and 392 days [IQR 203.5-1907.5] (p = 0.20), respectively. In conclusion, both topical and systemic GCV treatments demonstrated favorable outcomes for CMV AU. Systemic GCV showed rapid control of intraocular inflammation.
Subject(s)
Antiviral Agents , Cytomegalovirus Infections , Ganciclovir , Uveitis, Anterior , Humans , Male , Female , Middle Aged , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/virology , Uveitis, Anterior/drug therapy , Uveitis, Anterior/virology , Antiviral Agents/therapeutic use , Antiviral Agents/administration & dosage , Retrospective Studies , Treatment Outcome , Ganciclovir/therapeutic use , Ganciclovir/administration & dosage , Aged , Cytomegalovirus , Adult , Valganciclovir/therapeutic use , Recurrence , Ophthalmic SolutionsABSTRACT
Introduction: Syphilis exhibits a wide range of clinical presentations, mimicking various systemic and ocular diseases. Ocular syphilis, in particular, manifests with multiple presentations, ranging from anterior uveitis to panuveitis, making it a potential differential diagnosis for Behçet's uveitis. Here, we present a unique case of Behçet's panuveitis that was undergoing immunomodulatory therapy and was complicated by ocular syphilis. Notably, this case also featured rare cutaneous manifestations associated with secondary syphilis, commonly known as malignant syphilis. Case Presentation: A 38-year-old Thai man with refractory end-stage Behçet's panuveitis reported a maculopapular rash accompanied by increased intraocular inflammation. The escalation of immunomodulatory therapy, intended to manage the provisional diagnosis of active ocular and cutaneous Behçet's disease, resulted in clinical deterioration, with the rash transforming into multiple noduloulcerative lesions. Despite negative serologic tests for syphilis at baseline before initiating immunomodulatory therapy, syphilis infection was eventually diagnosed following reevaluation and the observation of spirochetes in a skin biopsy specimen. The patient was treated with intravenous penicillin G, resulting in an improvement in intraocular inflammation and resolution of noduloulcerative rashes. Conclusion: Intraocular inflammation and mucocutaneous lesions in syphilis can mimic the presentation of Behçet's disease. The introduction of immunomodulatory therapy may alter the clinical picture, leading to a severe and atypical presentation. A high index of suspicion for reevaluating serologic tests or performing tissue biopsies is warranted for an accurate diagnosis.
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BACKGROUND: To determine the prevalence, clinical characteristics, and independent predictors of uveitic macular edema (UME) in patients with intermediate, posterior and panuveitis. METHODS: We retrospectively reviewed the records of patients with intermediate, posterior, and panuveitis who underwent macular assessment using optical coherence tomography between January 2015 and February 2020. The prevalence of UME and clinical characteristics of the patients were described. Predictors of UME were identified using multivariate regression analysis. RESULTS: A total of 349 patients were included. The mean age was 41 years, female: male ratio was 1.3:1. The prevalence of UME was 51.9%. UME was found in 33.9%, 56.9%, and 54.1% of the intermediate, posterior, and panuveitis cases, respectively. Among patients with UME, 47% had infectious uveitis, 32.6% had idiopathic uveitis, and 20.4% had immune-mediated uveitis. Diffuse macular edema was the most frequently observed pattern (36.5%). Multivariate analysis showed that factors independently associated with UME included age at uveitis onset (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00-1.03, P = 0.036), PU and panuveitis compared with intermediate uveitis (aOR 2.09, 95% CI 1.14-3.86, P = 0.018), and infectious uveitis compared with noninfectious uveitis (aOR 2.13, 95% CI 1.34-3.37, P = 0.001). CONCLUSIONS: Increasing age at uveitis onset, posterior/panuveitis, and infectious etiology are predictive factors for UME in patients with intermediate, posterior and panuveitis.
Subject(s)
Macular Edema , Tomography, Optical Coherence , Uveitis , Humans , Retrospective Studies , Male , Female , Macular Edema/epidemiology , Macular Edema/diagnosis , Adult , Prevalence , Tomography, Optical Coherence/methods , Middle Aged , Uveitis/epidemiology , Uveitis/diagnosis , Visual Acuity , Risk Factors , Young Adult , Singapore/epidemiologyABSTRACT
PURPOSE: To investigate for association between skin autofluorescence (SAF) advanced glycation end products (AGEs) and uveitis/scleritis activity in systemic inflammatory disease-related active non-infectious uveitis/scleritis patients. METHODS: This cross-sectional study was conducted at Siriraj Hospital during October 2019 to March 2020. AGEs were measured by SAF method in systemic immune-related disease patients with active uveitis/scleritis, and those results were compared with those of healthy age-matched controls. RESULTS: Thirty-one active non-infectious uveitis/scleritis patients and 31 age-matched controls were enrolled. The mean age of patients was 40.0 ± 12.8 years, and most were female (55.0%). The most common associated systemic immune-related disease was Vogt-Koyanagi-Harada disease (n = 14). Mean SAF AGE level in the study group compared to the control group was 2.38 ± 0.66 arbitrary units (AU) versus 2.58 ± 0.56 AU, respectively (p = 0.20). Multivariate analysis showed decreased SAF AGE level to be significantly associated with active ocular inflammation, (odds ratio: 0.01, 95% confidence interval: 0.00004-0.81; p = 0.04). CONCLUSIONS: SAF AGE level was not so far found to be a reliable biomarker for indicating uveitis/scleritis activity in systemic immune-related disease patients with active ocular inflammation. CLINICAL TRIAL REGISTRATION: Thai Clinical Trials Registry, https://www.thaiclinicaltrials.org/ . (Reg. No. TCTR20200114004, registered date 01/01/2020, beginning date of the trial 10/01/2019).
Subject(s)
Scleritis , Uveitis , Adult , Female , Humans , Male , Middle Aged , Cross-Sectional Studies , Glycation End Products, Advanced , Inflammation , Uveitis/diagnosisABSTRACT
This study investigated the efficacy of golimumab in the management of refractory non-infectious panuveitis. Nineteen patients (38 eyes; mean age, 31 years) were retrospectively reviewed between June 2016 and June 2022. All patients had bilateral eye involvement and Behçet's disease was the most common diagnosis (57.9%). Compared to the period before golimumab treatment, the rate of uveitis relapses after golimumab treatment significantly decreased from 1.73 to 0.62 events per person-years (incidence ratio 0.33, 95% confidence interval 0.19-0.57, P < 0.001). After golimumab therapy, 12 patients (63.2%) were able to reduce the number or dosage of immunosuppressive drugs, and the median dosage of systemic corticosteroids was reduced from 15.0 to 7.5 mg/d (P = 0.013) compared to baseline. The median logMAR visual acuity improved from 0.9 at baseline to 0.6 at the last visit (P = 0.006). Golimumab demonstrated efficacy against refractory non-infectious panuveitis in terms of a corticosteroid-sparing effect and reduced the rate of uveitis relapses to approximately one-third.
Subject(s)
Antibodies, Monoclonal , Behcet Syndrome , Uveitis , Humans , Adult , Retrospective Studies , Uveitis/drug therapy , Uveitis/diagnosis , Behcet Syndrome/drug therapy , Behcet Syndrome/diagnosis , Adrenal Cortex Hormones/therapeutic use , Recurrence , Treatment OutcomeABSTRACT
PURPOSE: To investigate the incidence of and predictive factors for recurrent cytomegalovirus retinitis (CMVR) in human immunodeficiency virus (HIV)-negative patients. METHODS: A retrospective review of HIV-negative patients who were newly diagnosed with CMVR between January 2005 and February 2019. RESULTS: Of 28 patients (44 eyes), 35.9% of eyes had a recurrence of CMVR after discontinuation of anti-CMV therapy. The incidence of CMVR recurrence was 17 per 100 eye-years. The factors significantly associated with CMVR recurrence were eyes with retinitis area of more than 25% (P = .013), absence of vitreous haze (P = .003), neutropenia at presentation (P = .001), and absence of systemic immunosuppression therapy prior to presentation (P = .002). CONCLUSION: Eyes with a large area of retinitis, absence of vitreous haze, and neutropenia at presentation are predictive of CMVR recurrence while receiving systemic immunosuppression prior to CMVR presentation has a lower risk of CMVR recurrence.
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OBJECTIVE: The efficiency of B-cell depletion therapy for severe ocular cicatricial pemphigoid (OCP) highlights the key role of B lymphocytes in the immunopathogenesis of OCP. B-cell activating factor (BAFF) is a potent B-cell growth factor and costimulator of immunoglobulin production. Elevated serum BAFF is associated with systemic autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis and bullous pemphigoid. We hypothesize that serum BAFF levels are also increased in patients with OCP. METHODS: Sera were collected from 30 patients with new-onset active OCP, 9 with disease in remission, 10 with OCP relapse, and 15 healthy control individuals. An enzyme-linked immunosorbent assay was performed to measure the concentration of serum BAFF. RESULTS: BAFF was significantly higher in patients with new-onset active OCP (700.8 ± 181.8 pg/mL) than in healthy control individuals (564.1 ± 133.2 pg/mL; pâ¯=â¯0.014). No significant difference was found between patients with OCP in remission (585.4 ± 216.2 pg/mL) and healthy control individuals. Patients with disease relapse treated with rituximab had an extremely high concentration of BAFF (1721.9 ± 790.8 pg/mL). Longitudinal analysis of serum BAFF from 6 patients showed that BAFF decreased as the disease went from new onset (895.0 ± 240.8 pg/mL) to remission (625.4 ± 199.8 pg/mL; pâ¯=â¯0.003). CONCLUSIONS: BAFF is involved in the active inflammation of OCP. Targeting BAFF with an antagonist may be therapeutically beneficial for patients with refractory OCP, especially those resistant to rituximab.
ABSTRACT
Extranodal natural killer/T-cell lymphoma rarely presents as intraocular masquerade syndrome. We thank Dr. Evereklioglu for bringing up the importance of a thorough ocular examination, differential diagnosis, and consideration of the characteristics of ocular masquerade syndrome.
Subject(s)
Lymphoma, Extranodal NK-T-Cell , Panuveitis , Diagnosis, Differential , Humans , Killer Cells, Natural/pathology , Lymphoma, Extranodal NK-T-Cell/diagnosis , Lymphoma, Extranodal NK-T-Cell/pathology , Panuveitis/diagnosis , Vision Disorders/diagnosisABSTRACT
A prospective randomized control trial of 140 eyes from 140 patients, who underwent phacoemulsification, was conducted to compare the efficacy of subtenon corticosteroids injection with corticosteroids eye drops for controlling postoperative intraocular inflammation. Seventy patients received subtenon 20-mg triamcinolone injection (TA group), whereas the other 70 patients received 0.1% dexamethasone eye drops (Dexa group) after the uneventful surgeries. We examined and measured anterior chamber inflammation (ACI) score, laser flare-cell metering, conjunctival redness, pain, discomfort, visual acuity, intraocular pressure, and central foveal thickness on 1, 7, 14, 28 and 90 days postoperatively. At one month after the surgery, full recovery (zero ACI score) was found in 43 patients (63.20%) in the Dexa group versus 47 patients (68.10%) in the TA group (p = 0.55). There were no statistically significant differences in aqueous cells (p = 0.37) and flare (p = 0.86) between the two groups at one month. All participants experienced no serious adverse events. In conclusion, we found no statistically significant difference between subtenon 20-mg triamcinolone injection and 0.1% dexamethasone eye drop to control inflammation postoperatively. A single subtenon 20-mg triamcinolone injection could be an alternative anti-inflammatory treatment for an uneventful phacoemulsification.
Subject(s)
Phacoemulsification , Anti-Inflammatory Agents/therapeutic use , Dexamethasone , Glucocorticoids , Humans , Inflammation/drug therapy , Inflammation/etiology , Inflammation/prevention & control , Ophthalmic Solutions , Phacoemulsification/adverse effects , Prospective Studies , Triamcinolone AcetonideABSTRACT
Tuberculous uveitis (TBU) comprises a broad clinical spectrum of ocular manifestations, making its diagnosis challenging. Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU. Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens, resultant test positivities are low in yield. Immunodiagnostic tests, including the tuberculin skin test and interferon-gamma release assays (IGRAs), can help support a clinical diagnosis of TBU. Unlike the tuberculin skin test, IGRAs are in vitro tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination. Currently, available IGRAs consist of different techniques and interpretation methods. Moreover, newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis. This narrative review collates salient practice points as a reference for general ophthalmologists, such as evidence for the utilization of IGRAs in patients with suspected TBU, and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting.
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PURPOSE: To report a case of subretinal gnathostomiasis presenting with progressive subretinal tracts of a living parasite and successfully treated with focal laser photocoagulation. METHOD: Observational case report. PATIENT: A 29-year-old Thai male complained of blurred vision and floaters in his left eye for two weeks. An ocular examination showed multiple, whitish, subretinal tracks at the superotemporal retina. After 5 days of oral albendazole, a moving parasite was confirmed by multimodal retinal imaging. An immunoblotting analysis was positive for Gnathostoma species. RESULT: The patient was treated by laser photocoagulation with frequency-doubled Nd:YAG laser around and over the parasite. Oral albendozole was continued and naproxen was prescribed for four weeks. His vision improved to 20/20 and the inflammation subsided completely within three months. The patient has been followed for five years without local and systemic complications. CONCLUSIONS: Focal laser photocoagulation without systemic steroids could be a successful treatment for active subretinal gnathostomiasis with a satisfactory safety profile in a long-term follow-up.
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BACKGROUND: Extranodal natural killer/T-cell lymphoma (ENKTL), nasal type, generally affects the orbit by direct extension. It can even rarely present as severe intraocular inflammation mimicking endophthalmitis. Delayed diagnosis and treatment are frequently reported. CASE PRESENTATION: A 43-year-old woman presented with 2-month blurred vision in her left eye. Ocular examination revealed hypopyon panuveitis. She was initially diagnosed with endogenous endophthalmitis, which proved irresponsive to antimicrobial therapy. High-dose prednisolone was given afterward, but this failed to stop the development and continuous progression of ocular inflammation. The diagnosis of ENKTL was finally confirmed from the pathological findings of oral ulcers and cervical lymph nodes and chemotherapy was prescribed. After the first cycle of chemotherapy, the patient's ocular inflammation subsided. Unfortunately, her left eye became phthisis with progressive visual loss within 9 months following the diagnosis. CONCLUSIONS: The diagnosis of intraocular ENKTL is frequently delayed, which can lead to severe problems for treatment as the disease is aggressive with a poor prognosis. It can be found not only in elderly patients but also in a middle-aged individual. In patients with ocular inflammation, a thorough systemic evaluation and histopathological examination of the associated systemic findings is extremely helpful and may reveal the cause of the ocular inflammation, including revealing possible ENKTL.
Subject(s)
Eye Neoplasms , Intraocular Lymphoma , Lymphoma, Extranodal NK-T-Cell , Panuveitis , Adult , Aged , Female , Humans , Killer Cells, Natural , Lymphoma, Extranodal NK-T-Cell/diagnosis , Lymphoma, Extranodal NK-T-Cell/drug therapy , Middle Aged , Panuveitis/diagnosis , Panuveitis/drug therapyABSTRACT
To evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65-62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.
Subject(s)
Endophthalmitis/microbiology , Adolescent , Adult , Aged , Child , Child, Preschool , Endophthalmitis/epidemiology , Female , Humans , Klebsiella/pathogenicity , Male , Middle Aged , Retrospective Studies , Staphylococcus/pathogenicity , Thailand/epidemiology , Uveal Diseases/physiopathology , Visual Acuity/physiology , Young AdultABSTRACT
To identify triggering factors for the next inflammatory episode of recurrent acute anterior uveitis (RAAU), a 1:1 case-control study was conducted. We interviewed RAAU patients with recent acute anterior uveitis attack and quiescent controls for their information during a previous month using Srithanya Stress Test (ST-5) and questionnaires about potential triggering factors. Asymptomatic controls were matched for age (± 5 years), sex, and HLA-B27. There were 39 pairs of cases and controls. Patients who recently experienced a uveitis attack demonstrated higher mean ST-5 scores (3.7 ± 2.9 vs 0.7 ± 1.1) and shorter sleep time (6.3 ± 1.4 vs 7.4 ± 0.7 h per day) compared with their controls. In the multivariate conditional logistic regression analysis, ST-5 score ≥ 3 (OR 9.07, 95% CI 1.14-72.16, p = 0.037) and sleep time < 7 h per day (OR 12.12, 95% CI 1.37-107.17, p = 0.025) were more likely to trigger a uveitis attack in RAAU accounted for patients' age, sex, HLA- B27 positivity, and presence of concurrent anti-inflammatory drugs for co-existing diseases. Other suspected triggering factors were not found to have any significant association. In short, stress and inadequate sleep may lead to the future episode of acute anterior uveitis in RAAU. Both physical and emotional stress management should be advised to RAAU patients to minimize recurrences and further complications.
Subject(s)
HLA-B27 Antigen/metabolism , Sleep Deprivation/complications , Stress, Physiological , Uveitis, Anterior/epidemiology , Acute Disease , Case-Control Studies , Female , Humans , Male , Middle Aged , Recurrence , Thailand/epidemiology , Uveitis, Anterior/etiology , Uveitis, Anterior/pathologyABSTRACT
To demonstrate the demographics, associated factors, clinical presentations, microbiology, management, visual outcome and complications of keratitis/scleritis-related endophthalmitis (KSE). A retrospective chart of all endophthalmitis patients diagnosed between September 2001 and August 2011 was reviewed. Only endophthalmitis cases with previous corneal or scleral infection were included in the study. The patients were followed until losing vision or eyeball, becoming phthisis, or the end of 2018. Eighty-seven patients with KSE were identified, all unilateral. The mean age was 56.4 ± 21.4 years. There was a slight male predilection (55 patients, 63.2%). The mean follow-up time was 50 ± 149 weeks. The causative pathogens were identified in 35 patients (40.2%), with the highest frequency being bacteria. The most common bacterium was Pseudomonas aeruginosa (n = 13), and the most common fungus was Aspergillus sp. (n = 5). Fifteen patients achieved (17.2%) final visual acuity (VA) of hand motion or better after treatment. Eyeball removal was performed in 61 (70.1%) patients. From multivariate analysis, the only prognostic factor for poor final VA (worse than hand motion, HM) was poor VA (worse than HM) at the initial visit (relative risk 1.97, 95% confidence interval 1.15-3.36, p = 0.013). KSE is uncommon but has a devastating outcome. We found that the patient's initial VA was the only predictor for their final vision. P. aeruginosa was the most common identifiable organism in this study. However, several fungal infections were recognised. These findings should raise awareness for treatment of KSE in the tropics.
Subject(s)
Endophthalmitis/epidemiology , Keratitis/epidemiology , Scleritis/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Disease Progression , Endophthalmitis/drug therapy , Endophthalmitis/etiology , Female , Hospitals, University , Humans , Infant , Keratitis/complications , Keratitis/drug therapy , Male , Middle Aged , Prognosis , Retrospective Studies , Scleritis/complications , Scleritis/drug therapy , Sex Factors , Thailand/epidemiology , Treatment Outcome , Young AdultABSTRACT
To evaluate extralesional microvascular and structural changes of the macula using optical coherence tomography angiography (OCTA) and structural OCT in cytomegalovirus retinitis (CMVR). An observational study of CMVR patients were performed. Complete ophthalmic examination, serial color fundus photography, structural OCT and OCTA were performed at baseline and follow-up visits for up to 12 months. The structural OCT was analyzed to evaluate macular areas within, bordering and beyond the CMVR lesions. Extralesional retinal capillary plexus of the macula were evaluated by OCT angiography and compared with the unaffected fellow eyes. Thirteen eyes from 13 patients were enrolled. At baseline, macular areas without CMVR lesions showed decreased vessel density (VD) of both the superficial (P = 0.0002) and deep (P < 0.0001) retinal capillary plexus in eyes with CMVR as compared with the corresponding macular areas of the unaffected fellow eyes. The decrease of VD persisted through the follow-up period for up to 12 months after adjusting for degree of vitreous haze. Structural macular OCT characteristics at the borders and beyond the lesions included intraretinal hyperreflective dots, cystoid macular edema, subretinal fluid and selective ellipsoid zone (EZ) loss. The selective EZ loss found in 6 of 12 eyes showed recovery in 4 eyes after receiving anti-viral treatment. In CMVR eyes, there were microvascular and microstructural abnormalities in the macular area without clinically visible CMVR lesions. Our results provided interesting insights into CMV infection of the retina.
Subject(s)
Cytomegalovirus Retinitis/diagnostic imaging , Macula Lutea/blood supply , Macula Lutea/pathology , Adult , Cytomegalovirus Retinitis/pathology , Female , Fluorescein Angiography , Humans , Macula Lutea/diagnostic imaging , Male , Microvascular Density , Middle Aged , Tomography, Optical Coherence , Young AdultABSTRACT
BACKGROUND: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis. METHODS: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized. RESULTS: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients' age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60. CONCLUSIONS: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner's suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Nontuberculous Mycobacteria/isolation & purification , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Aminoglycosides/therapeutic use , Cataract Extraction/adverse effects , Endophthalmitis/epidemiology , Endophthalmitis/microbiology , Female , Fluoroquinolones/therapeutic use , Humans , Immunocompromised Host , Macrolides/therapeutic use , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/epidemiology , Mycobacterium Infections, Nontuberculous/microbiology , Postoperative Complications/microbiology , Thailand/epidemiology , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Although atypical mycobacteria had been increasingly found in various ocular infections in the past decades, a slow-growing Mycobacterium haemophilum (M. haemophilum) was scarcely reported. Similar to tuberculous infection, the presentation can masquerade as low-grade granulomatous intraocular inflammation with partial response to corticosteroids. Besides, the special requirements for culture make this pathogen difficult to diagnose. The study aims to report the clinical presentation and notify the awareness of NTM endophthalmitis among clinicians. This is the first case report of late-onset, postoperative M. haemophilum endophthalmitis in the literature. CASE PRESENTATION: A 66-year-old man with non-insulin-dependent diabetes mellitus (NIDDM) manifested chronic granulomatous inflammation in the left eye after multiple glaucoma surgeries. With a diagnosis of noninfectious panuveitis, he was treated with systemic corticosteroids. The inflammation initially responded to therapy although it subsequently worsened and became purulent endophthalmitis. The vitreous cultures grew M. haemophilum. Intraocular and systemic antimicrobial treatments were administered early, but the patient eventually turned blind. CONCLUSIONS: M. haemophilum endophthalmitis is a rare but serious intraocular complication leading to loss of vision or eyeball. Awareness of atypical mycobacterial infections is necessary especially in patients with impaired immune function, previous intraocular surgery, and corticosteroid resistance. Proper laboratory investigations and treatments should be performed. However, due to the rarity of the disease, the development of guidelines for its investigation and therapy is still challenging.
Subject(s)
Endophthalmitis/etiology , Mycobacterium Infections/etiology , Mycobacterium haemophilum/pathogenicity , Postoperative Complications/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Diabetes Mellitus, Type 2/complications , Endophthalmitis/drug therapy , Endophthalmitis/microbiology , Glaucoma/surgery , Humans , Male , Mycobacterium Infections/drug therapy , Mycobacterium Infections/microbiology , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Uveitis/etiologyABSTRACT
PURPOSE: To describe a proportion of uveitis and to analyse differences between immune-related uveitis and infectious uveitis groups. METHODS: A retrospective study of 458 uveitis patients were categorized into immune-related uveitis, infectious uveitis, masquerade, and undetermined groups. The pattern of inflammation was described. Subgroup analysis was performed to compare pattern differences between immune-related uveitis and infectious uveitis groups. RESULTS: The most common location of inflammation was the anterior eye segment. Vogt-Koyanagi-Harada disease was the most common identifiable cause. From multivariate analysis, variables found to be significantly different between immune-related uveitis group and infectious uveitis group were age of onset, presence of systemic autoimmune diseases, HIV infection, and laterality. CONCLUSIONS: Idiopathic anterior uveitis was the most prevalent diagnosis. Vogt-Koyanagi-Harada disease was the most common identifiable uveitis. Most immune-related uveitis patients were young and presented with chronic bilateral panuveitis, with most patients in the infectious uveitis group presenting with chronic unilateral posterior uveitis.