Management of nontuberculous mycobacterial infections of the
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Nontuberculous mycobacterial (NTM) infections of the eye and orbit are an uncommon but serious complication of intraocular and orbital surgeries. Reported cases include infectious keratitis, endophthalmitis, and scleral buckle infections, typically involving Mycobacterium chelonae, M. fortuitum, and M. abscessus. Published case studies and reviews report a combination of topical drops, intravitreal injections, systemic antibiotics, and/or surgical removal of foreign material if indicated as part of the management of these infections.

A research was conducted to provide an update on different management approaches for Nontuberculous Mycobacterial (NTM) infections of the eye and orbit.

A total of 9 eyes from 8 patients were found to meet study criteria. Of these 9 eyes, 6 eyes (66%) involved Mycobacterium abscessus, 2 (22%) involved M. chelonae, and 1 (11%) involved M. fortuitum. In 8 (88%) eyes, NTM infection was treated with a combination of antibiotics and removal of involved foreign body or tissue (e.g. scleral buckle, intraocular lens, orbital implant, or granuloma). One case was observed on topical therapy alone due to low suspicion for clinically significant infection. In 1 patient, a second culture-positive infection was found in the contralateral eye requiring treatment.

Although rare, NTM infections are an important differential to consider when encountering ocular infections in the setting of prior surgery and the presence of ocular implants, as timely intervention can minimize morbidity. Depending on the clinical scenario, using combination antibiotics based on antimicrobial susceptibility testing and/or surgical intervention may provide definitive management of these infections. Collaboration between ophthalmology and infectious disease specialists is recommended to help elucidate the best course of action for treatment of mycobacterial infections of the eye and orbit.