Early surgical intervention beneficial in Nocardia infection following intraocular surgery

Dr. Devesh Sharma and associates conducted a retrospective review to evaluate the outcome of ocular nocardiosis following intraocular surgery.The researchers found that in all such cases early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.The Study has been published in Indian Journal of Ophthalmology, the official journal of All India Ophthalmological Society.

Postoperative infections after intraocular surgical procedures caused by Nocardia are rare and potentially sight-threatening but encouraging results have been noted in isolated case reports. The present retrospective analysis was conducted to evaluate the clinical outcomes of Nocardia infections after intraocular surgery.

The researchers performed a retrospective review of medical records of all postoperative cases of culture proven Nocardia infection over a period of 3 years, from October 2010 to September 2013, was performed. Microbiological analysis was performed for all cases and included smears and cultures. Fortified 2% amikacin eye drops were the mainstay of treatment. Surgical intervention was performed in case of nonresponse to medical therapy or suspected endophthalmitis.

In the study, seven cases of culture proven Nocardia infection were seen. All cases had been operated in a hospital surgical facility. Six followed phacoemulsification, and one followed a secondary intraocular lens implantation. Four patients were part of a cluster infection. The mean duration between the primary surgical procedure and presentation was 16.14 ± 9.82 days. Five patients had infiltrates at the site of the surgical incision. One each had endophthalmitis and panophthalmitis. Six eyes required surgical intervention. Infection was seen to resolve in four eyes. Two eyes went into phthisis, and one was eviscerated. Only two of the six eyes, where in surgical intervention was performed early, obtained a final visual acuity of 20/60.

The authors concluded that in Nocardia infection following intraocular surgery, early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.

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Sharma D, Mathur U, Gour A, Acharya M, Gupta N, Sapra N. Nocardia infection following intraocular surgery: Report of seven cases from a tertiary eye hospital. Indian J Ophthalmol [serial online] 2017 [cited 2017 Jun 22];65:371-5. Available from: http://www.ijo.in/text.asp?2017/65/5/371/207447