Tarkkanen Ahti, Raivio Virpi, Anttila Veli-Jukka, Tommila Petri, Ralli Reijo, Merenmies Lauri, Immonen Ilkka
Ophthalmic Pathology Laboratory, Helsinki University Eye Hospital, Helsinki, Finland.
Acta Ophthalmol Scand. 2004 Apr;82(2):232-5. doi: 10.1111/j.1600-0420.2004.00235.x.
To report a case of delayed fungal endophthalmitis by Paecilomyces variotii following uncomplicated cataract surgery. To our knowledge this is the first reported case of postoperative endophthalmitis by this species.
We report the longterm clinical follow-up of an 83-year-old female who underwent uncomplicated sutureless, small-incision cataract surgery. She developed recurring uveitis 4 months after surgery. Vitreous tap and finally complete vitrectomy with removal of the capsular bag including the intraocular lens were performed. Fungi were studied by histopathology and culture.
At histopathological examination, the fungi were found to be closely related with the capsular bag. A few mononuclear inflammatory cells were encountered. At culture, Paecilomyces variotii, a common ubiquitous non-pathogenic saprophyte, was identified. Despite systemic, intravitreal and topical antifungal therapy after vitrectomy the uveitis recurred several times, but no fungal organisms were isolated from the repeat intraocular specimen. At 18 months postoperatively the subject's visual acuity was finger counting at 2 metres. At the time of surgery the operating room air-conditioning system was undergoing repairs. Cases of fungal endophthalmitis after contamination from air-conditioning ventilation systems have been reported before, but none of the cases reported have been caused by P. variotii.
P. variotii, a non-pathogenic environmental saprophyte, may be disastrous if introduced into the eye. International recommendations on the environmental control of the operating room air-conditioning ventilation system should be strictly followed. No intraoperative surgery should be undertaken while the air-conditioning system is undergoing repairs or service.
报告1例单纯性白内障手术后发生的由拟青霉引起的迟发性真菌性眼内炎。据我们所知，这是该菌种引起的术后眼内炎的首例报道病例。
我们报告了1例83岁女性患者的长期临床随访情况，该患者接受了单纯性无缝线小切口白内障手术。术后4个月出现复发性葡萄膜炎。进行了玻璃体穿刺，最终进行了完全玻璃体切除术，切除了包括人工晶状体在内的囊袋。通过组织病理学和培养对真菌进行了研究。
组织病理学检查发现，真菌与囊袋密切相关。发现了一些单核炎性细胞。培养时，鉴定出拟青霉，这是一种常见的无处不在的非致病性腐生菌。尽管玻璃体切除术后进行了全身、玻璃体内和局部抗真菌治疗，但葡萄膜炎仍复发了几次，但从重复的眼内标本中未分离出真菌。术后18个月，患者的视力为2米手指计数。手术时手术室空调系统正在维修。以前曾有过空调通风系统污染后发生真菌性眼内炎的病例报道，但所报道的病例均不是由拟青霉引起的。
拟青霉是一种非致病性环境腐生菌，如果进入眼内可能会造成灾难性后果。应严格遵循关于手术室空调通风系统环境控制的国际建议。空调系统进行维修或保养时不应进行术中手术。
