Seth Praveen Kumar, Sharma Savitri, Senthil Sirisha
Glaucoma, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.
BMJ Case Rep. 2020 Mar 24;13(3):e234175. doi: 10.1136/bcr-2019-234175.
A one-eyed 67-year-old man with 20/400 vision, dense cataract, previously failed trabeculectomy and medically uncontrolled advanced glaucoma underwent a single-site phacoemulsification with repeat trabeculectomy and mitomycin C. One-week postoperatively, vision in the right eye improved to 20/120, good bleb and intraocular pressure (IOP) of 14 mm Hg. By third postoperative week, patient presented to the emergency with diminished vision, pain and redness in right eye of 2 days duration and was diagnosed to have bleb-related endophthalmitis (BRE). Vitreous biopsy, smear from the bleb were taken and underwent pars plana vitrectomy with intraocular antibiotic injection. Smears and cultures were negative however, aqueous DNA-PCR was positive for Revisited history revealed treated pulmonary tuberculosis 3 years ago with a positive Mantoux test (17 mm) and hilar prominence on chest X-ray. One month after starting anti-tubercular therapy (ATT), the BRE resolved and vision improved to 20/60 with IOP of 14 mm Hg and the ATT was continued.
一名67岁独眼男性，视力为20/400，患有致密性白内障，既往小梁切除术失败且药物治疗无法控制晚期青光眼，接受了单切口超声乳化联合重复小梁切除术及丝裂霉素C治疗。术后一周，右眼视力提高到20/120，形成良好的滤过泡，眼压（IOP）为14毫米汞柱。术后第三周，患者因右眼视力下降、疼痛和眼红2天就诊于急诊，被诊断为滤过泡相关眼内炎（BRE）。进行了玻璃体活检、取滤过泡涂片，并接受了经睫状体平坦部玻璃体切除术及眼内抗生素注射。涂片和培养结果均为阴性，但房水DNA聚合酶链反应（PCR）检测结核分枝杆菌呈阳性。回顾病史发现患者3年前曾接受肺结核治疗，结核菌素试验（曼托试验）呈阳性（17毫米），胸部X光显示肺门突出。开始抗结核治疗（ATT）一个月后，BRE得到缓解，视力提高到20/60，眼压为14毫米汞柱，继续进行ATT治疗。
