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Unusual case series of Post -operative endophthalmitis due to Mycobacterium tuberculosis

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.

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Unusual case series of Post -operative endophthalmitis due to Mycobacterium tuberculosis

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  1. 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 Aravind Eye Care System

  2. 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 .

  3. Left Eye Ocular and Microbiological Examination

  4. 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 .

  5. 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.

  6. Right eye Ocular and Microbiological Examination

  7. 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 . Acid Fast Bacilli Colonies on L.J. medium

  8. 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 .

  9. Right eye Ocular and Microbiological Examination

  10. 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 Avastinwas given for neovascular glaucoma with standard oral and topical anti – glaucoma medications . • Total Pars planavitrectomy 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 .

  11. Tunnel Infiltrate : at presentation Case 1 Case 2 Case 3 Tunnel Infiltrate at : 3 months Case 2 Case 3 Case 1

  12. 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 .

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