Seles S, Lang G E
Augenklinik, Universitätsklinikum Ulm, Ulm, Germany.
Klin Monbl Augenheilkd. 2007 Jul;224(7):606-8. doi: 10.1055/s-2007-963338.
Infectious infiltrations of the retina and the vitreous in endogenous infections such as septicaemia are rare.
A 42-year-old woman presented complaining about a defect of her visual field in the right eye. The patient reported about a feeling of illness and high temperature up to 39.5 degrees C since two weeks.
At the first examination the patient had a best corrected visual acuity of 1.25 in her right eye and 1.0 in her left eye. A focal infiltration of the retina with a circumscribed haemorrhage was found on ophthalmoscopy and fluorescein angiography, located on the temporal superior vein. One day later a circumscribed vitreous infiltration was seen in this area. The ophthalmological findings and the fever of unknown origin led to the tentative diagnosis of a retinal infiltration due to an infectious disease. Internal examinations revealed a subacute endocarditis caused by viridans streptococci. Under intravenous antibiotic treatment the infiltration of the retina and vitreous declined quickly. A complete healing of the ophthalmological findings was found 3 weeks later.
Since the subacute endocarditis in infections caused by viridans streptococci is characterized by a lingering start of the disease with high temperature of unknown origin and an unspecific feeling of illness, the ophthalmological findings can manifest itself before the diagnosis of the underlying disease is made. Complications such as blindness after fulminant endophthalmitis and death can be avoided through quick diagnosis and treatment.
在内源性感染如败血症中，视网膜和玻璃体的感染性浸润很少见。
一名42岁女性因右眼视野缺损前来就诊。患者自述两周以来一直感觉不适且高烧至39.5摄氏度。
首次检查时，患者右眼最佳矫正视力为1.25，左眼为1.0。眼底镜检查和荧光素血管造影发现视网膜有局灶性浸润并伴有局限性出血，位于颞上静脉。一天后，在该区域可见局限性玻璃体浸润。眼科检查结果和不明原因发热导致初步诊断为感染性疾病引起的视网膜浸润。内科检查发现由草绿色链球菌引起的亚急性心内膜炎。在静脉注射抗生素治疗下，视网膜和玻璃体的浸润迅速消退。3周后眼科检查结果完全恢复。
由于草绿色链球菌引起的感染中的亚急性心内膜炎的特点是疾病起病隐匿，伴有不明原因的高烧和非特异性的不适感觉，眼科检查结果可能在潜在疾病诊断之前就已出现。通过快速诊断和治疗，可以避免暴发性眼内炎后失明和死亡等并发症。
