Singh Supreet, Patel Chirag V, Kishore Kamal
Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Capital Health Medical Center, Hopewell, New Jersey, USA.
Case Rep Ophthalmol. 2017 Oct 30;8(3):510-514. doi: 10.1159/000480727. eCollection 2017 Sep-Dec.
We present a case of acute endophthalmitis caused by spp. following intravitreal bevacizumab injection. An 86-year-old immunocompetent female developed acute endophthalmitis after intravitreal injection of bevacizumab for neovascular age-related macular degeneration. The patient presented with pain, visual acuity of hand motions, hypopyon, and dense vitritis 96 h after treatment. She was treated with vitreous and anterior chamber tap followed by intravitreal injections of 1 mg vancomycin, 2.25 mg ceftazidime, and 400 μg dexamethasone. Cultures revealed growth of spp., a genus of gram-positive bacteria that is inherently resistant to vancomycin. Due to persistent inflammation, pars plana vitrectomy (PPV) with intravitreal injection of 0.4 mg amikacin was performed 16 days later, followed by resolution of endophthalmitis and return of vision to 20/40. In conclusion, the management of acute endophthalmitis caused by spp., a gram-positive coccobacillus, can be particularly challenging due to its inherent resistance to vancomycin. PPV with intravitreal amikacin led to resolution of endophthalmitis. Our case expands the number of cases of endophthalmitis caused by spp. and highlights the possibility of -related endophthalmitis in an outpatient setting in an immunocompetent host.
我们报告了1例玻璃体内注射贝伐单抗后由[具体菌种]引起的急性眼内炎病例。一名86岁免疫功能正常的女性因新生血管性年龄相关性黄斑变性接受玻璃体内注射贝伐单抗后发生急性眼内炎。治疗96小时后，患者出现疼痛、手动视力、前房积脓和浓密的玻璃体炎。她接受了玻璃体和前房穿刺，随后玻璃体内注射1 mg万古霉素、2.25 mg头孢他啶和400 μg地塞米松。培养结果显示[具体菌种]生长，该菌属革兰氏阳性菌，对万古霉素天然耐药。由于炎症持续存在，16天后进行了玻璃体切割术（PPV）并玻璃体内注射0.4 mg阿米卡星，随后眼内炎消退，视力恢复到20/40。总之，由革兰氏阳性球杆菌[具体菌种]引起的急性眼内炎的治疗可能特别具有挑战性，因为其对万古霉素天然耐药。玻璃体切割术联合玻璃体内注射阿米卡星可使眼内炎消退。我们的病例增加了由[具体菌种]引起的眼内炎病例数量，并突出了在免疫功能正常宿主的门诊环境中发生[具体菌种]相关眼内炎的可能性。
