Raghavan Anita, Veerappan Saravanan, Rangarajan Viji, Rajaraman Revathi, Salian Romit, Mk Janani, L Dhanurekha, Ganesh Vr Ram, Venkatapathy Narendran, Rammohan Ram
Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
Medical Research Foundation, Sankara Nethralaya Referral Laboratory, Chennai, Tamil Nadu, India; and.
Cornea. 2020 Aug;39(8):1055-1058. doi: 10.1097/ICO.0000000000002289.
To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery.
Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis.
Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology.
Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.
报告一例白内障手术顺利后发生棘阿米巴性眼内炎的病例。
对一例经活检证实的棘阿米巴性眼内炎病例进行描述、治疗及预后分析。
在其他地方进行常规白内障手术后两天，患者因根据发病时间和严重程度被诊断为细菌感染而出现急性眼内炎。当传统治疗方法无效时，患者被转诊至我院。仅非典型环形浸润的存在提示棘阿米巴可能为病因。随后的诊断评估证实了最初的怀疑。尝试使用局部抗阿米巴药物以及前房内和玻璃体内注射伏立康唑进行治疗。还给予了全身应用伏立康唑和甲硝唑。然而，由于病情持续进展，不得不对患眼进行眼球摘除术。角膜、房水、玻璃体和巩膜经培养和/或聚合酶链反应及组织病理学检查均呈阳性。
棘阿米巴通常引起慢性隐匿性角膜炎，极少引起巩膜炎。本报告为首例此类报告，强调了在无明显眼科病史的免疫功能正常个体中，眼科手术后可发生伴有巩膜炎的暴发性眼内炎这一事实。
