unusual case series of post -operative endophthalmitis due to mycobacterium tuberculosis
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Unusual case series of Post -operative endophthalmitis due to Mycobacterium tuberculosis. Dr. Thiruvengada Krishnan , M.D. , Aravind Eye Hospital Pondicherry , India Co- Authors – Dr Deeksha , MD , Dr R.D. Ravindran , MD Authors have no financial interest. - PowerPoint PPT PresentationTRANSCRIPT
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Unusual case series of Post -operative
endophthalmitis due to Mycobacterium
tuberculosisDr. Thiruvengada Krishnan , M.D. , Aravind Eye Hospital
Pondicherry , IndiaCo- Authors – Dr Deeksha ,
MD , Dr R.D. Ravindran , MD
Authors have no financial interest
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Case 1• 64 years old male patient presented with
diminution of vision and redness of left eye for 10 days . Underwent uneventful temporal section Phacoemulsification cataract surgery and in the bag intraocular lens implantation , 1 month back .
• On anti- tuberculous ( A.T.T.) treatment for past 2 months and Chest X-ray showed bilateral apical fibrotic changes.
• Ocular examination right eye – B.C.V.A was 6/9 with early nuclear sclerosis .
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Left Eye Ocular and Microbiological Examination
V/A at presentation of L/E
6 / 60 B.C.V.A.
Tunnel infiltrate L/E 3 x 3 mm temporally
A. C. Reaction L/E Grade 4 + flare and cells and fibrin membrane
U.S.G. B Scan L/E Suggestive of endophthalmitis
A.C. and vitreous tap L/E Negative for microbiological examination
Tunnel infiltrate scraping specimen L/E
Positive A.F.B. and grew colonies on L.J. medium and P.C.R. positive for
mycobacterium T.B.
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Management and clinical course
• Intraocular inflammation responded well to continuation of systemic A.T.T.
• Topically - fortified amikacin , vigamox , ketlur LS and atropine eyedrops were instilled .
• B.C.V.A. left eye stabilized at 6/12 at the end of 3 months .
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Case 2• 77 years old female presented with blurred
vision and pain right eye for 2 days . Underwent uncomplicated Phacoemulsification and in the bag intraocular lens implantation via temporal section 2 months back .
• On treatment for Diabetes mellitus Type II for 7 years .
• Ocular examination left eye – B.C.V.A. 6/9 with intraocular lens in the bag and no diabetic retinopathy.
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Right eye Ocular and Microbiological Examination
V/A at presentation of R/E
6/12 B.C.V.A.
Tunnel infiltrate R/E 2 x 2 mm temporally
A/C Reaction R/E Grade III flare and cells
U.S.G. B Scan R/E Suggestive of endophthalmitis
A.C. and vitreous tap R/E
Negative for microbiological examination
Tunnel infiltrate scraping specimen R/E
Positive A.F.B. and grew colonies on L.J. medium and P.C.R. positive for
mycobacterium T.B.
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Management and clinical course• Intraocular inflammation responded well
with institution of systemic A.T.T. and topically - fortified amikacin , vigamox , ketlur LS and atropine eyedrops were instilled .
• B.C.V.A. right eye stabilized at 6/18 p at the end of 3 months .
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Case 3• 57 years old male presented with right eye
redness and pain , 1 month following uncomplicated Phacoemulsification and in the bag intraocular lens implantation , via temporal section .
• Ocular examination left eye – B.C.V.A. 6/12 with nuclear sclerosis .
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Right eye Ocular and Microbiological Examination
V/A at presentation of R/E
6 / 24 p B.C.V.A.
Tunnel infiltrate R/E 3 x 3 mm temporally
A/C Reaction R/E Grade IV flare and cells with fibrin membrane and 1mm hypopyon
U.S.G. B Scan R/E Suggestive of endophthalmitis and Tractional Retinal Detachment
A.C. and vitreous tap R/E Negative for microbiological examination
Tunnel infiltrate scraping specimen R/E
Positive A.F.B. and grew colonies on L.J. medium and P.C.R. positive for
mycobacterium T.B.
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Management and Clinical course• Intraocular inflammation responded well with institution
of systemic A.T.T. and topically with fortified amikacin , vigamox , ketlur LS and atropine eyedrops .
• Intracameral 0.05 cc Avastin was given for neovascular glaucoma with standard oral and topical anti – glaucoma medications .
• Total Pars plana vitrectomy with intra - vitreal silicone oil was done for tractional retinal detachment .
• B.C.V.A. right eye stabilized at 6/36 at the end of 3 months .
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Tunnel Infiltrate : at presentation
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Conclusion
• Mycobacterium tuberculosis is a possible etiology in post - operative endophthalmitis cases , especially pertinent in set up of tropical countries , where tuberculosis is endemic .
• A high index of suspicion aids in timely diagnosis and guiding management to salvage the eye and vision restoration .