Division of Nephrology, Faculty of Medicine, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Ren Fail. 2012;34(1):119-22. doi: 10.3109/0886022X.2011.623557. Epub 2011 Oct 21.
There are many infectious complications related to vascular access in patients undergoing maintenance hemodialysis. We report two cases of endophthalmitis as a metastatic infection associated with a tunneled catheter and a temporary dual lumen catheter. Both patients were diabetic. A 61-year-old female on maintenance hemodialysis by a jugular tunnelized catheter during the past year was receiving parenteral antibiotics for catheter salvage due to fever episodes in the last 3 months. She was admitted to the hospital presenting pain, proptosis, conjunctival hyperemia, corneal infiltrate, and visual acuity of no light perception (NLP). A 51-year-old male recently undergoing hemodialysis by a temporary dual lumen catheter presented fever. His catheter was removed, but he was admitted to the hospital presenting fever, decreased vision, edema, and pain in his left eye. On examination, eyelid edema, conjunctival hyperemia, purulent secretion, hypopyon in the pupils, and visual acuity of NLP were verified. A diagnosis of endogenous endophthalmitis was made in both patients on clinical grounds and computed tomography. Evisceration of the left eye was the first option of treatment for both patients due to poor vision. Cultures of the eviscerated ocular globes showed Staphylococcus hemolyticus and Staphylococcus aureus, respectively. After evisceration, both patients received treatment, had a good outcome, and were discharged to continue their hemodialysis program. Metastatic bacterial endophthalmitis is a rare complication of dialysis catheter-related bacteremia. When suspected, urgent ophthalmologic evaluation and treatment are needed to reduce the risk of losing vision in the affected eye.
在接受维持性血液透析的患者中，有许多与血管通路相关的感染并发症。我们报告了两例隧道导管和临时双腔导管相关的眼内炎作为转移性感染的病例。这两例患者均为糖尿病患者。一位 61 岁的女性患者在过去一年中通过颈内隧道导管进行维持性血液透析，由于近 3 个月出现发热，正在接受全身抗生素治疗以挽救导管。她因疼痛、眼球突出、结膜充血、角膜浸润和无光感（NLP）而入院。一位 51 岁的男性患者最近通过临时双腔导管进行血液透析，出现发热。他的导管被移除，但他因发热、视力下降、水肿和左眼疼痛而入院。检查发现眼睑水肿、结膜充血、脓性分泌物、瞳孔中出现前房积脓和 NLP 视力。根据临床和计算机断层扫描结果，两名患者均被诊断为内源性眼内炎。由于视力不佳，左眼眼球摘除术是两名患者的首选治疗方法。眼球摘除的眼标本培养分别显示出溶血性葡萄球菌和金黄色葡萄球菌。眼球摘除术后，两名患者均接受了治疗，结果良好，出院继续进行血液透析治疗。转移性细菌性眼内炎是透析导管相关菌血症的罕见并发症。怀疑时，需要紧急眼科评估和治疗，以降低受影响眼睛失明的风险。
