Kimura Daisaku, Sato Takaki, Suzuki Hiroyuki, Kohmoto Ryohsuke, Fukumoto Masanori, Tajiri Kensuke, Kobayashi Takatoshi, Kida Teruyo, Ikeda Tsunehiko
Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan.
Department of Ophthalmology, Takatsuki Red Cross Hospital, Takatsuki, Japan.
Case Rep Ophthalmol. 2017 Jun 6;8(2):334-340. doi: 10.1159/000477160. eCollection 2017 May-Aug.
To report a case of rhegmatogenous retinal detachment in the late stage, despite the fact that it had previously been halted after intravitreal injection of an antimicrobial agent against endogenous bacterial endophthalmitis (EBE).
This study involved a 62-year-old male who had previously been diagnosed with septicemia due to liver abscess and the detection of in a culture of his liver abscess, and who underwent ophthalmic examination after his conjunctival hyperemia had failed to improve. Visual acuity could not be measured due to his general condition being poor and his declining level of consciousness. Slit lamp examination revealed bilateral iritis and cataracts, and the fundus was invisible due to vitreous opacity. Ultrasonic B-mode examination showed subretinal abscess and exudative retinal detachment, leading to the diagnosis of EBE. Vitreous injections of antibiotics were administered to both of his eyes. His right eye became affected by phthisis bulbi, but the condition in his left eye subsided, leaving a scarred lesion near the macula. However, complete retinal detachment occurred in his left eye approximately 10 months after the vitreous injection. During vitreous surgery, proliferative membrane formation was observed in the posterior pole area, and an irregular retinal break was detected in the scar margin caused by the traction of the proliferative membrane. After vitreous surgery, the retina was reattached under silicone oil.
In cases of EBE, even if the inflammation has previously subsided, strict follow-up examinations are necessary, since complications such as rhegmatogenous retinal detachment may occur at a late stage.
报告一例晚期孔源性视网膜脱离病例，尽管此前玻璃体腔内注射抗内源性细菌性眼内炎（EBE）抗菌药物后病情曾得到控制。
本研究涉及一名62岁男性，他此前因肝脓肿被诊断为败血症，肝脓肿培养物中检测到[具体病菌未提及]，结膜充血未改善后接受眼科检查。由于其全身状况差且意识水平下降，无法测量视力。裂隙灯检查显示双侧虹膜炎和白内障，因玻璃体混浊无法看到眼底。B超检查显示视网膜下脓肿和渗出性视网膜脱离，诊断为EBE。双眼均行玻璃体腔注射抗生素。右眼发生眼球痨，但左眼病情消退，黄斑附近留下瘢痕性病变。然而，玻璃体腔注射后约10个月，左眼发生了完全性视网膜脱离。玻璃体手术中，在后极部区域观察到增殖膜形成，在增殖膜牵拉导致的瘢痕边缘检测到不规则视网膜裂孔。玻璃体手术后，视网膜在硅油下复位。
在EBE病例中，即使炎症此前已消退，也有必要进行严格的随访检查，因为晚期可能会发生孔源性视网膜脱离等并发症。
