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Nontuberculous Mycobacterial Infection After Clear Corneal Phacoemulsification Cataract Surgery: A Report of 13 Cases

Lim Bon Siong, Ruben MD; Felipe, Anthony F. MD

doi: 10.1097/ICO.0b013e31826cf840
Clinical Science

Purpose: To review the patient profile, clinical presentation, management, and outcomes of nontuberculous mycobacterial (NTM) infection after clear corneal phacoemulsification.

Methods: Review of consecutive cases diagnosed with NTM infection after phacoemulsification from 2004 to 2009. Demographic data, clinical characteristics, diagnosis, treatment, and outcomes were analyzed.

Results: Thirteen eyes of 13 patients with mean age of 61.1 years, consisting of 7 men and 6 women were included. Twelve of 13 eyes (92%) underwent uncomplicated clear cornea phacoemulsification with posterior lens implant. Mean interval from surgery to onset of symptoms was 6.3 weeks, and time to referral ranged from 2 days to 9 months. Ten eyes (77%) presented with stromal wound abscess, whereas 3 (23%) appeared as iridocyclitis with posterior capsule plaques. Five eyes were clustered while the rest were isolated cases. All cases were culture positive for NTM. Two cases were treated medically, 3 had removal of lens implant and capsule, and 8 had penetrating keratoplasty with or without removal of lens implant, iridectomy, and/or pars plana vitrectomy. After a mean follow-up of almost 22 months, best-corrected visual acuity of 20/40 or better was achieved in half of the cases (54%). One case of recurrence was noted.

Conclusions: NTM infection should be suspected in patients presenting with corneal stromal wound abscess or iridocyclitis with posterior capsular plaques 6 to 7 weeks after phacoemulsification. Early diagnosis and treatment can lead to good outcomes, and management should include a combination of medical and surgical therapies.

*Department of Ophthalmology and Visual Sciences, Sentro Oftalmologico Jose Rizal, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines

Institute of Ophthalmology and Visual Sciences, International Eye Institute, St. Luke's Medical Center, Quezon City, Philippines

Cornea Service, Wills Eye Institute, Philadelphia, PA.

Correspondence: Ruben Lim Bon Siong, Department of Ophthalmology and Visual Sciences, Sentro Oftalmologico Jose Rizal, University of the Philippines Manila, Philippine General Hospital, Taft Ave, Manila 1000, Philippines (e-mail: rubenlbs2000@yahoo.com).

Dr Lim Bon Siong is a consultant for Alcon, Allergan, Bausch and Lomb, and is on the speaker's bureau for Carl Zeiss Meditec, Alcon, Allergan, Novartis, and Bausch and Lomb. For the remaining author, none was declared.

Received November 14, 2011

Accepted August 1, 2012

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