Nocardia endophthalmitis after cataract surgery: clinicomicrobiological study

PURPOSE: To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: setting: Tertiary referral hospital. patients: Retrospective analysis of 24 cases of culture-proven exogenous nocardial endophthalmitis following cataract surgery between January 2000 and December 2003. main outcome measures: Visual acuity and anatomic outcome. RESULTS: Visual outcome was poor in most patients, with 79% (19/24) of patients obtaining a final visual acuity of hand motions or worse and 46% (11/24) of patients with no light perception. Initial presenting visual acuity was strongly associated with final visual outcome (P = .0026). There was a statistically significant trend favoring better visual outcome in patients who presented early after the onset of symptoms (P = .01). The majority of the eyes (23/24) had an early onset with predominantly anterior segment involvement. Wound infection was noted in 46% (11/24) of the patients at presentation. Clinical features included scleral abscess, cotton ball exudates in the anterior chamber, fluffy exudates on the corneal endothelium, nodular exudates on the iris, and hypopyon. Among the specimens cultured, the highest positivity was seen with the anterior chamber aspirate (15/16 = 93.75%), which was significantly higher than the vitreous aspirate cultured (1/22 = 4.54%) (P = .001). CONCLUSION: Nocardia endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis. Early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcome.