Patel Sagar B, Reddy Nikitha, Hogan Robert N, Cao Jennifer H
J Pediatr Ophthalmol Strabismus. 2017 Jun 29;54:e37-e41. doi: 10.3928/01913913-20170531-07.
A 9-month-old male infant with a history of Down syndrome underwent bilateral medial rectus recession. Two weeks postoperatively, he developed leukocoria of the left eye with a white opacity posterior to the lens, numerous undulations, necrosis, and hemorrhages in the retrolental space. His contralateral eye had white retinal lesions nasally. Ultrasound examination of the left eye showed a funnel retinal detachment, loculated debris, and a small, central, hyperechoic area concerning for calcification. He underwent enucleation because retinoblastoma could not be definitively ruled out. Given this patient's low visual potential, enucleation was a definitive and safe treatment option. Ocular pathology showed significant inflammation and necrosis. There was an area of scleral perforation by a suture adherent to the retina and vitreous, surrounded by inflammatory cells. This case uniquely demonstrates pediatric endophthalmitis following strabismus surgery, secondary to scleral perforation confirmed by histopathological analysis. Care must be taken during scleral passage of sutures to prevent inadvertent scleral perforation and the potential complication of endophthalmitis. [J Pediatr Ophthalmol Strabismus. 2017;54:e37-e41.].
一名患有唐氏综合征的9个月大男婴接受了双侧内直肌后徙术。术后两周，他左眼出现白瞳症，晶状体后方有白色混浊，视网膜后间隙有许多波动、坏死和出血。他的对侧眼鼻侧有白色视网膜病变。左眼超声检查显示漏斗状视网膜脱离、局限性碎屑以及一个小的中央高回声区，考虑有钙化。由于不能明确排除视网膜母细胞瘤，他接受了眼球摘除术。鉴于该患者视力潜力较低，眼球摘除术是一种明确且安全的治疗选择。眼部病理学检查显示有明显炎症和坏死。有一处巩膜被附着于视网膜和玻璃体的缝线穿孔，周围有炎性细胞。该病例独特地展示了斜视手术后发生的小儿眼内炎，组织病理学分析证实其继发于巩膜穿孔。在巩膜缝线穿过时必须小心，以防止意外的巩膜穿孔和眼内炎这一潜在并发症。[《小儿眼科与斜视杂志》。2017年；54:e37 - e41。]
