Nocardia endophthalmitis after cataract surgery: clinicomicrobiological study.
OBJECTIVE
To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery.


METHODS
Retrospective, observational case series.


METHODS
setting: Tertiary referral hospital. patients: Retrospective analysis of 24 cases of culture-proven exogenous nocardial endophthalmitis following cataract surgery between January 2000 and December 2003. main outcome measures: Visual acuity and anatomic outcome.


RESULTS
Visual outcome was poor in most patients, with 79% (19/24) of patients obtaining a final visual acuity of hand motions or worse and 46% (11/24) of patients with no light perception. Initial presenting visual acuity was strongly associated with final visual outcome (P = .0026). There was a statistically significant trend favoring better visual outcome in patients who presented early after the onset of symptoms (P = .01). The majority of the eyes (23/24) had an early onset with predominantly anterior segment involvement. Wound infection was noted in 46% (11/24) of the patients at presentation. Clinical features included scleral abscess, cotton ball exudates in the anterior chamber, fluffy exudates on the corneal endothelium, nodular exudates on the iris, and hypopyon. Among the specimens cultured, the highest positivity was seen with the anterior chamber aspirate (15/16 = 93.75%), which was significantly higher than the vitreous aspirate cultured (1/22 = 4.54%) (P = .001).


CONCLUSIONS
Nocardia endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis. Early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcome.
Haripriya
Aravind
A
Centre for Advancement in Cataract Services, Aravind Eye Care System, Aravind Eye Care Hospital and Postgraduate Institute of Ophthalmology, 1 Anna Nagar, 625 020 Madurai, Tamil Nadu, India.
Lalitha
Prajna
P
Mathen
Minu
M
Prajna
Namperumalsamy Venkatesh
NV
Kim
Ramasamy
R
Shukla
Dhananjay
D
Natchiar
Govindappa
G
Srinivasan
Muthiah
M
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000382:microbiology; D002387:Cataract Extraction; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014792:Visual Acuity; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents