Nontuberculous Mycobacterial Ocular Infections: A Systematic Review of the Literature

Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome

Nontuberculous mycobacterial ocular infections: a systematic review of the literature

Nontuberculous or atypical mycobacterial ocular infections have been increasing in prevalence over the past few decades. They are known to cause periocular, adnexal, ocular surface and intraocular infections and are often recalcitrant to medical therapy. These infections can potentially cause detrimental outcomes, in part due to a delay in diagnosis. We review 174 case reports and series on nontuberculous mycobacterial (NTM) ocular infections and discuss etiology, microbiology, risk factors, diagnosis, clinical presentation, and treatment of these infections. History of interventions, trauma, foreign bodies, implants, contact lenses, and steroids are linked to NTM ocular infections. Steroid use may prolong the duration of the infection and cause poorer visual outcomes. Early diagnosis and initiation of treatment with multiple antibiotics are necessary to achieve the best visual outcome

Glaucoma Drainage Implants

Glaucoma drainage implants are generally used to manage medically uncontrolled glaucoma when trabeculectomy has failed or is unlikely to succeed. All glaucoma drainage implants consist of a tube that connects to an end plate. Drainage implants differ in their design with respect to the size, shape, and material composition of the end plate, and whether a valve is present or absent. A similar surgical technique is used for placement of all glaucoma drainage implants. The surgical results that are achieved after implant surgery depend upon the type of glaucoma treated and type of implant used. Intraoperative and postoperative complications may develop with glaucoma drainage implant surgery related to implantation of a foreign body

Treatment Outcomes of Primary Transscleral Cyclophotocoagulation

To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes. Retrospective noncomparative study. Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery. Continuous-wave TSCPC was applied to the ciliary body. The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP > 5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications. Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP >21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P < 0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P < 0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed. Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg

Treatment Outcomes of Slow Coagulation Transscleral Cyclophotocoagulation In Pseudophakic Patients with Medically Uncontrolled Glaucoma

Reporting treatment outcomes of slow coagulation transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in pseudophakic glaucomatous patients. Retrospective case series. Single academic center. Seventy-four pseudophakic patients (mean age of 82.6 ±12.5 years and mean follow-up of 18.7±9.1 months) with a diagnosis of glaucoma and no previous glaucoma surgeries. Slow coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration) MAIN OUTCOME MEASURES: Primary outcome measure was surgical success defined as an IOP 6 - 21 mmHg with reduction ≥ 20% from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Secondary outcome measures include glaucoma medication use, visual acuity (VA), and complications. IOP decreased from 27.5±9.8 mmHg preoperatively to 16.1±6.3 mm Hg postoperatively (P 21 mmHg (high group) or ≤ 21 mmHg (low group), success rates at 2 years were 64.9% and 45.5%, respectively (P = 0.144). Mean logMAR VA changed from 0.70 ± 0.64 to 1.04±0.87 at the last follow-up visit (P= 0.01). No serious complications were observed and most of the complications were mild and transient. Slow coagulation TSCPC has good efficiency, especially in patients with baseline IOP > 21 mm Hg, and safety profile as an initial surgical intervention in pseudophakic glaucomatous patients