Oh In Kyung, Baek Sehyun, Huh Kuhl, Oh Jaeryung
Department of Ophthalmology, Anam Hospital, Korea University College of Medicine, 26-1 Anam-dong 5-ga, Sungbuk-gu, Seoul, 136-705, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2007 Jan;245(1):164-6. doi: 10.1007/s00417-006-0325-3. Epub 2006 Apr 13.
A posterior subtenon injection of triamcinolone acetonide is an alternative to intravitreal injection in diabetic macular edema and is known to have fewer vision-threatening complications. Here, we report a case of periocular abscess following posterior subtenon injection of triamcinolone.
A 62-year-old woman who had diabetic macular edema and disc neovascularization underwent a posterior subtenon injection of triamcinolone acetonide and panretinal laser photocoagulation. One month later a periocular abscess was noted in the inferotemporal area adjacent to the scleral wall. Pus was removed by fine-needle aspiration, and microbiologic cultures identified Pseudallescheria boydii. The patient was given systemic and subconjunctival treatment with itraconazole. However, conjunctival infection and anterior chamber inflammation worsened, and another posterior subtenon abscess was found.
Despite long-term systemic and topical itraconazole therapy, retinal detachment and vitreous opacity were shown on B-scan, and atrophic bulbi resulted.
Pseudallescheria boydii infection of the eye and orbit can result in a poor visual outcome. Prompt surgical debridement and drainage of the abscess, along with appropriate antifungal therapy based on susceptibility testing, must be mandatory.
曲安奈德后Tenon囊下注射是糖尿病性黄斑水肿玻璃体腔内注射的一种替代方法，且已知其具有较少的威胁视力的并发症。在此，我们报告1例曲安奈德后Tenon囊下注射后发生眼周脓肿的病例。
1例患有糖尿病性黄斑水肿和视盘新生血管的62岁女性接受了曲安奈德后Tenon囊下注射和全视网膜激光光凝术。1个月后，在紧邻巩膜壁的颞下区域发现一个眼周脓肿。通过细针穿刺抽出脓液，微生物培养鉴定为波氏假阿利什菌。给予患者伊曲康唑全身及结膜下治疗。然而，结膜感染和前房炎症加重，且发现了另一个后Tenon囊下脓肿。
尽管进行了长期的伊曲康唑全身及局部治疗，但B超显示视网膜脱离和玻璃体混浊，最终导致眼球萎缩。
眼部和眼眶的波氏假阿利什菌感染可导致不良的视觉预后。必须立即进行脓肿的手术清创和引流，并根据药敏试验进行适当的抗真菌治疗。
