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Ophthalmic Images
November 9, 2017

Bleb-Associated Exogenous Nocardia Endophthalmitis

Author Affiliations
  • 1Emory Eye Center, Emory University, Atlanta, Georgia
  • 2Palmetto Retina Center, West Columbia, South Carolina
JAMA Ophthalmol. 2017;135(11):e174276. doi:10.1001/jamaophthalmol.2017.4276

A woman in her 60s with known human leukocyte antigen B27 positivity was referred for protracted intraocular inflammation and intractable pain 5 months after trabeculectomy in the right eye. On presentation, best-corrected visual acuity was 20/100. Ultrasonographic imaging showed moderate vitritis, and slitlamp examination mirrored this (Figure, A).

Anterior chamber aspirates, which required a vitrector to extract, demonstrated filamentous, acid-fast, gram-positive nocardia (Figure, B). Despite aggressive treatment with intravitreal amikacin/vancomycin and oral cotrimoxazole, guided by culture and sensitivity analyses, the eye was ultimately enucleated.

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