Baskaran Prabu, Ramakrishnan Seema, Dhoble Pankaja, Gubert Joseph
Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India.
GMS Ophthalmol Cases. 2016 Feb 2;6:Doc01. doi: 10.3205/oc000038. eCollection 2016.
To report a case of beta-hemolytic streptococcal endophthalmitis following crane-pecking injury.
A twelve-year-old boy was brought to us by his father with history of crane beak injury in his right eye. On examination, his vision was 6/24 Snellen's acuity. Anterior segment examination showed a full thickness two mm corneo-limbal tear at 1 o'clock with iris prolapse. Pupil showed peaking through the wound with a clear crystalline lens. There was no evidence of hypopyon in the anterior chamber and B-scan ultrasonography showed acoustically clear vitreous with an attached retina. Left eye was within normal limits. Primary corneo-limbal tear repair was performed within 24 hours from the time of presentation. Intra-operatively, the corneal surgeon noted turbid aqueous with minimal hypopyon. In view of clinical suspicion of infection, an intravitreal tap for culture was taken during the primary repair, and prophylactic intravitreal antibiotics were given. The culture report showed beta-hemolytic streptococci. Pars plana vitrectomy with intravitreal antibiotics was performed after 2 days as serial ultrasound scans showed appearance and worsening of endophthalmitis. A month after the surgery, his best corrected visual acuity improved to 6/12.
Ocular injuries resulting from bird pecking are very rare. We treated a case of full thickness corneo-limbal tear with endophthalmitis caused by beta-hemolytic streptococci following a crane-pecking injury. We recommend that injecting intravitreal antibiotics along with primary globe repair in case of severe/contaminated injuries and early pars plana core-vitrectomy would result in better outcome like in our case.
报告一例鹤啄伤后发生的β溶血性链球菌性眼内炎病例。
一名12岁男孩被其父亲带到我们这里，他有右眼被鹤喙啄伤的病史。检查时，其视力为Snellen视力表6/24。前段检查显示在1点钟方向有一个2毫米全层角膜缘裂伤，伴有虹膜脱出。瞳孔通过伤口呈尖峰状，晶状体透明。前房无积脓迹象，B超检查显示玻璃体声学清晰，视网膜附着正常。左眼正常。在就诊后24小时内进行了原发性角膜缘裂伤修复。术中，角膜外科医生注意到房水混浊，有少量积脓。鉴于临床怀疑感染，在初次修复时进行了玻璃体腔穿刺培养，并给予预防性玻璃体腔抗生素。培养报告显示为β溶血性链球菌。由于系列超声扫描显示眼内炎出现并加重，2天后进行了玻璃体切割联合玻璃体腔注射抗生素手术。术后一个月，他的最佳矫正视力提高到了6/12。
鸟类啄伤导致的眼外伤非常罕见。我们治疗了一例鹤啄伤后发生的全层角膜缘裂伤合并β溶血性链球菌性眼内炎病例。我们建议，对于严重/污染性损伤，在进行眼球初期修复的同时注射玻璃体腔抗生素，早期行玻璃体切割术，会像我们的病例一样取得更好的效果。
