Ono Takashi, Mori Yosai, Nejima Ryohei, Iwasaki Takuya, Amano Shiro, Miyata Kazunori
Miyata Eye Hospital, Miyazaki, Japan.
Inouye Eye Hospital, Tokyo, Japan.
Case Rep Ophthalmol. 2018 Feb 14;9(1):154-159. doi: 10.1159/000487076. eCollection 2018 Jan-Apr.
Chestnut burrs, the thorny encapsulation of chestnut fruit, can sometimes cause corneal injuries and ulceration, with poor prognoses. We report a case of corneal perforation and damaged anterior lens capsule due to a chestnut burr, using anterior segment optical coherence tomography (AS-OCT). A 67-year-old woman with a chestnut burr injury in her right eye was referred to our hospital. Her right best-corrected visual acuity (BCVA) was 0.8. Slit-lamp examination and AS-OCT showed perforation involving the endothelial layer at the center of the cornea. The iris and anterior lens capsule were damaged. Cell infiltration was observed around the wound. Bacterial examination showed gram-positive cocci but no fungi. The patient was diagnosed with a corneal perforation and bacterial keratitis. Levofloxacin 1.5% and cefmenoxime treatments were initiated and a soft contact lens was placed to seal the wound. On day 3, there was no improvement in the corneal cell infiltration, but AS-OCT suggested that the inner wound had closed. A culture test revealed the presence of , which was sensitive to both levofloxacin and cefmenoxime. Therefore, we continued the same antibiotic treatment. On day 26, the opacification and cell infiltration at the center of the cornea had improved. AS-OCT showed healing of the corneal wound with reduction in the central corneal thickness. Her BCVA improved to 1.0. AS-OCT was a valuable tool to noninvasively observe wound shape and detect the presence of any intracorneal foreign bodies.
板栗刺，即板栗果实的带刺外壳，有时会导致角膜损伤和溃疡，预后较差。我们报告一例因板栗刺导致角膜穿孔和晶状体前囊受损的病例，使用了眼前节光学相干断层扫描（AS-OCT）。一名67岁右眼被板栗刺刺伤的女性被转诊至我院。她的右眼最佳矫正视力（BCVA）为0.8。裂隙灯检查和AS-OCT显示角膜中央的穿孔累及内皮层。虹膜和晶状体前囊受损。伤口周围观察到细胞浸润。细菌检查显示革兰氏阳性球菌但无真菌。该患者被诊断为角膜穿孔和细菌性角膜炎。开始使用1.5%左氧氟沙星和头孢甲肟治疗，并放置软性接触镜以封闭伤口。第3天，角膜细胞浸润无改善，但AS-OCT提示内部伤口已闭合。培养试验显示存在[此处原文缺失具体细菌名称]，其对左氧氟沙星和头孢甲肟均敏感。因此，我们继续相同的抗生素治疗。第26天，角膜中央的混浊和细胞浸润有所改善。AS-OCT显示角膜伤口愈合，中央角膜厚度减小。她的BCVA提高到1.0。AS-OCT是一种无创观察伤口形状和检测角膜内任何异物存在的有价值工具。
