title: NOCARDIA CHOROIDAL ABSCESS: Risk Factors, Treatment Strategies, and Visual Outcomes.
abstract: OBJECTIVE
  To describe the risk factors, clinical course, ancillary test findings, treatment strategies, and visual outcomes of a series of patients with choroidal abscesses caused by endogenous Nocardia.
  
  
  METHODS
  This retrospective, consecutive noncomparative case series included all patients with Nocardia ocular infections at 3 tertiary medical centers over the past 20 years.
  
  
  RESULTS
  Five eyes in 5 patients were identified with choroidal abscesses because of Nocardia. All patients were immunocompromised: one suffered from AIDS and four had autoimmune disorders. Three of the 5 patients (60%) underwent systemic evaluation, and in all 3, nonocular nocardiosis was identified. Four patients (80%) underwent diagnostic ophthalmic surgery and received systemic and intravitreal antibiotics. The final patient deferred these interventions. Outcomes at the last follow-up examination were 20/25, 1/200, hand motion at 1 foot, and 2 patients underwent enucleation. Mean follow-up (± standard deviation) was 159 (± 103) days.
  
  
  CONCLUSIONS
  Immunosuppression is the most significant risk factor for developing Nocardia choroidal abscesses. Definitive diagnosis generally requires subretinal biopsy, which is also critical to implementing appropriate antibiotic therapy.
authors.affiliation: *Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; †Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and ‡Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
authors.forename: Ruwan A
authors.initials: RA
authors.lastname: Silva
authors.forename: Ryan
authors.initials: R
authors.lastname: Young
authors.forename: Jay
authors.initials: J
authors.lastname: Sridhar
mesh_terms: D000038:Abscess / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015862:Choroid Diseases / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D003131:Combined Modality Therapy; D015353:Eye Enucleation; D015818:Eye Infections, Bacterial / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents