OBJECTIVE : To report a case of recurrent mycobacterium abscessus complex endophthalmitis post cataract surgery, its clinical features and complex course, management, and treatment outcome.
METHOD : A retrospective medical chart review to determine its clinical features, management and treatment outcome.
RESULT : A 70 year-old female was referred for post cataract surgery chronic endophthalmitis five months after right eye cataract surgery. Despite intravitreal and topical antibiotic, she had multiple episodes of recurrent hypopyon uveitis upon tapering the topical steroid. This was followed by formation of whitish, fluffy, cotton-like material in the anterior chamber (AC) with scleral abscess. AC washout and incisional biopsy of the scleral were done followed by pars plana vitrectomy, intraocular lens explantation, and intravitreal antibiotic injection. Culture revealed Mycobacterium abscessus complex . Intravitreal vancomycin, ceftazidime and systemic clarithromycin, rifampicin and intramuscular streptomycin were commenced and her condition improved. However, hypopyon uveitis and scleral abscess recurred. Intravitreal amikacin, systemic amikacin, linezolid, clarithromycin and ciprofloxacin were commenced. Her eye remained quiescent till date without the need for evisceration.
CONCLUSION : Mycobacterium abscessus complex endophthalmitis post cataract surgery is rare. It often induces chronic recurrent or persistent intraocular inflammation. Diagnosis is often delayed due to low clinical suspicion. Keyword: endophthalmitis, non-tuberculous mycobacterium, cataract surgery, hypopyon uveitis, scleral abscess, fungal uveitis