case_images: PMC4014381_01
case_images: Clinical photographs.. Notes: (A) Patient's clinical presentation of herpes zoster ophthalmicus in 2002 (inset) with a slit-lamp photograph of his neurotrophic corneal ulcer in 2007. (B) Cyanoacrylate glue had been applied for the management of a perforated corneal descemetocele in April 2011. (C) Suspected vitreous prolapse from previous cataract surgery or accumulated fibrin that may have allowed passage of mycobacterial past the lens implant into the vitreous cavity (inset), and recurrent hypopyon. (D) Clear corneal graft and anterior chamber 1 month after the pars plana vitrectomy, anterior chamber washout, and intravitreal injections of antimicrobial and fungal agents (amikacin, 400 mug/0.1 mL; vancomycin, 1 mg/0.1 mL; and amphotericin B, 5 mug/0.1 mL).
case_images: opth-8-837Fig1.jpg
case_images: PMC4014381_01_opth-8-837Fig1.jpg
case_images: f1-opth-8-837
case_images: A 68-year-old pseudophakic male with long-standing neurotrophic keratopathy secondary to HZO characterized by a non-healing corneal ulcer (Figure 1A), was referred with a recurrent Seidel-positive cornea of the left eye. Examination revealed cyanoacrylate glue on the central cornea with slow aqueous leakage, diffuse deep vascularization, an inferior stromal infiltrate, and a 1.5 mm layered hypopyon (Figure 1B). AC, recurrent layered hypopyon (Figure 1C), mild anterior vitritis, and unaffected posterior vitreous were observed. A second vitreous tap and intravitreal injections of ceftazidime (2 mg/0.1 mL) and vancomycin (1 mg/0.1 mL) were administered based on prior responsiveness; however, this time, the patient did not improve. After surgery, the eye again returned to a quiet state without evidence of infection or inflammation (Figure 1D), until the patient returned 3 months post-vitrectomy with painless clouding of vision in the left eye.
case_images: Diagnostic images.. Notes: (A) B-scan ocular ultrasound demonstrating vitreous opacification (arrow) 20 days after the therapeutic penetrating keratoplasty. (B) Ziehl-Neelsen staining of the corneal host button showing red-stained acid-fast bacilli (arrows). Inset shows 2+ acid-fast rhodamine stain with potassium permanganate counterstain capturing one bacillus per high-powered field from the vitreous cassette obtained by pars plana vitrectomy.
case_images: opth-8-837Fig2.jpg
case_images: PMC4014381_01_opth-8-837Fig2.jpg
case_images: f2-opth-8-837
case_images: B-scan ultrasonography showed dense retrolental opacity, concerning for endophthalmitis (Figure 2A). Histopathology from the host corneal button subsequently demonstrated AFB, and cultures were reported as M. abscessus (Figure 2B).