Bleb-related tuberculous endophthalmitis following combined phacoemulsification and trabeculectomy with mitomycin C

BMJ Case Rep. 2020 Mar 24;13(3):e234175. doi: 10.1136/bcr-2019-234175.

Abstract

A one-eyed 67-year-old man with 20/400 vision, dense cataract, previously failed trabeculectomy and medically uncontrolled advanced glaucoma underwent a single-site phacoemulsification with repeat trabeculectomy and mitomycin C. One-week postoperatively, vision in the right eye improved to 20/120, good bleb and intraocular pressure (IOP) of 14 mm Hg. By third postoperative week, patient presented to the emergency with diminished vision, pain and redness in right eye of 2 days duration and was diagnosed to have bleb-related endophthalmitis (BRE). Vitreous biopsy, smear from the bleb were taken and underwent pars plana vitrectomy with intraocular antibiotic injection. Smears and cultures were negative however, aqueous DNA-PCR was positive for Mycobacterium tuberculosis Revisited history revealed treated pulmonary tuberculosis 3 years ago with a positive Mantoux test (17 mm) and hilar prominence on chest X-ray. One month after starting anti-tubercular therapy (ATT), the BRE resolved and vision improved to 20/60 with IOP of 14 mm Hg and the ATT was continued.

Keywords: eye; infections.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antitubercular Agents / therapeutic use
  • Endophthalmitis* / drug therapy
  • Endophthalmitis* / microbiology
  • Glaucoma* / therapy
  • Humans
  • Male
  • Mitomycin*
  • Mycobacterium tuberculosis
  • Phacoemulsification*
  • Postoperative Complications / drug therapy
  • Postoperative Complications / microbiology
  • Trabeculectomy*
  • Tuberculosis* / complications
  • Tuberculosis* / drug therapy

Substances

  • Antitubercular Agents
  • Mitomycin