Kim Eun Chul, Kim Man Soo, Kang Nam Yeo
Department of Ophthalmology & Visual Science, College of Medicine, Catholic University of Korea, Seoul, Korea.
Semin Ophthalmol. 2013 Mar;28(2):75-8. doi: 10.3109/08820538.2012.760613.
To report a case of fungal corneal ulcer and bacterial orbital cellulitis as complications of bacterial endophthalmitis following cataract surgery.
A 51-year-old man underwent anterior chamber irrigation and aspiration in the left eye one day after cataract surgery because of bacterial endophthalmitis. Marked lid swelling with purulent discharge was developed after 5 days. Slit lamp examination showed generalized corneal ulcer and pus in the total anterior chamber. A computerized tomography scan showed left retrobulbar fat stranding with thickened optic disc. Streptococcus pneumonia was cultured from corneal scraping, vireous, and subconjunctival pus.
The patient improved gradually with antibiotics treatments, but the corneal ulcer did not fully recover 2 months after cataract surgery. Candida albicans was detected in repetitive corneal culture. After antifungal and antibacterial therapy, the corneal epithelium had healed, but phthisis bulbi had developed.
Fungal corneal ulcer and bacterial orbital cellulitis can occur as complications of endophthalmitis in an immunocompetent patient.
报告一例白内障手术后细菌性眼内炎并发真菌性角膜溃疡和细菌性眼眶蜂窝织炎的病例。
一名51岁男性因白内障手术后细菌性眼内炎于术后一天行左眼前房冲洗和抽吸术。5天后出现明显的眼睑肿胀并伴有脓性分泌物。裂隙灯检查显示角膜广泛溃疡,整个前房有脓液。计算机断层扫描显示左眼球后脂肪条索状增粗,视盘增厚。角膜刮片、玻璃体和结膜下脓液培养出肺炎链球菌。
患者经抗生素治疗后逐渐好转,但白内障手术后2个月角膜溃疡仍未完全恢复。多次角膜培养检测到白色念珠菌。经过抗真菌和抗菌治疗后,角膜上皮愈合,但眼球萎缩已形成。
在免疫功能正常的患者中,真菌性角膜溃疡和细菌性眼眶蜂窝织炎可作为眼内炎的并发症发生。