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    General

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    Grand Rounds

    A patient with extensive past ocular history including bilateral severe stage uveitic secondary angle closure glaucoma with bilateral glaucoma drainage implants, long-standing inoperable retinal detachment in the left eye, and phacoemulfication with intraocular lens implant in the right eye presented with a 3-day history of right eye pain and decreased vision. On examination of the right eye, their visual acuity was hand motions, and the anterior segment exam was notable for conjunctival injection, exposure of the glaucoma drainage device and hypopyon. There was a poor view to the fundus. Ultrasound of the right eye revealed dense vitreous opacities. The patient underwent vitreous tap and intravitreal injection with Vancomycin and Ceftazidime. The patient was also started on fortified Vancomycin and Tobramycin eye drops and Moxifloxacin tablets the same day. The patient's pain improved on the following days. The Exposed glaucoma implant was removed on day 3. Due to increasing inflammation, the patient underwent pars plana vitrectomy, removal of hypopyon and release of posterior synechiae on day 5. Culture of the vitreous sample from the pars plana vitrectomy grow Mycobacterium abscessus. The patient was started on Amikacin eye drops and Clarithromycin tablets. On day 26, the patient reported pain in the right eye. The exam revealed worsening hypopyon and infectious scleritis over the area of prior tube. Due to infectious scleritis concern, the patient underwent surgical debridement of sclera, placement of a scleral patch graft, an anterior chamber wash out, intracameral and subconjunctival injection of Amikacin and cryotherapy. The patient is under long-term topical and oral antibiotic treatment with improvement in pain.

    Presentation Date: 10/02/2025
    Issue Date: 03/06/2026