PMC4808525_01
Fluffy white exudates in anterior chamber and surrounding the IOL in capsular bag.
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fig1
On slit lamp examination, left eye had corneal epithelial edema and fluffy white cotton ball-like exudates in the anterior chamber and the intraocular lens was surrounded by the same exudates in the capsular bag (Figure 1).
Ultrasound showing fine vitreous opacities with flat retina.
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Ultrasound of the eye showed fine vitreous opacities of low reflectivity with flat retina (Figure 2).
Gram-positive thin long beaded branching filaments of Nocardia.
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fig3
Direct microscopic examination of vitreous and anterior chamber fluid showed Gram-positive thin long beaded branching filaments and acid fast thin long filaments in modified acid fast staining (Kinyoun stain) (Figure 3).
Dry, raised, chalky white colonies of Nocardia on blood agar.
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On blood agar dry, raised, chalky white colonies were seen after 2 days of incubation (Figure 4).
Cloudy swelling, cotton wool spots, and scattered intraretinal haemorrhages.
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fig5
Anterior segment was quiet, mildly hazy vitreous and the macula was pale and cloudy looking with multiple intraretinal hemorrhages (Figure 5).
Fluorescein angiogram showing macular arteriolar occlusion with staining of the arteriolar walls along superior and inferior arcades.
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Fluorescein angiography showed multiple capillary nonperfusion areas (Figure 6).
OCT showing increased macular thickness.
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The OCT showed increased macular thickness (central foveal thickness 342 mum), hyperreflectivity of inner retinal layers corresponding to areas of retinal edema (Figure 7).
Macular edema subsided.
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fig8
The vision improved to counting fingers at 2 meters and the macular edema subsided (Figure 8).
Hyperdense and adherent RPE and retinal layers.
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fig9
On OCT, the macular thickness had decreased but the differentiation of different retinal layers was not evident and foveal centre showed hyper dense and adherent RPE and retinal layers (Figure 9).