Nishikasai Inouye Eye Hospital, Tokyo, Japan.
Edogawa Hospital, Tokyo, Japan.
BMC Ophthalmol. 2020 Jun 5;20(1):217. doi: 10.1186/s12886-020-01487-w.
The usefulness of povidone-iodine as an alternative to antimicrobial agents, for endophthalmitis, has recently been documented. We report a case of endogenous endophthalmitis successfully treated with intravitreal injection of povidone-iodine.
An 88-year-old woman underwent small bowel bypass surgery for postoperative ileus following rectal cancer resection. She developed a fever during total parenteral nutrition and was diagnosed with gram-positive cocci bacteremia of central venous catheter origin. The patient was referred to our department with chief complaints of ocular pain, hyperemia and decreased vision in the right eye, which had manifested during the febrile period. The initial examination revealed the visual acuity in her right eye to be finger counting and that in her left eye 0.2. The right eye showed a severe inflammatory reaction in the anterior chamber, fibrin deposition, and hypopyon. The fundus was difficult to visualize. Endogenous endophthalmitis due to bacteria was diagnosed. Surgical treatment was judged to be difficult based on the patient's poor general condition and mental status, and intravitreal injection of 0.1 ml of 1.25% povidone-iodine was performed on the same day. The inflammation rapidly diminished, and the hypopyon had disappeared 4 days after treatment. The fundus became visible 7 days after treatment and there was no recurrence of endophthalmitis findings. The visual acuity in her right eye recovered to that in the left eye (0.2).
Intravitreal injection of povidone-iodine is potentially useful and effective as an alternative treatment of antibiotics for endogenous endophthalmitis patients, especially in whom surgical therapy is difficult.
聚维酮碘作为替代抗生素治疗眼内炎的有效性最近已经得到证实。我们报告了一例成功应用玻璃体腔内注射聚维酮碘治疗内源性眼内炎的病例。
一位 88 岁女性，因直肠癌术后肠麻痹行小肠旁路手术后，在全胃肠外营养期间出现发热，被诊断为中心静脉导管来源的革兰阳性球菌菌血症。该患者因右眼疼痛、充血和视力下降就诊，这些症状在发热期间出现。初次检查发现右眼视力为指数，左眼视力为 0.2。右眼前房有严重炎症反应，有纤维蛋白沉积和前房积脓。眼底难以观察。诊断为内源性细菌眼内炎。考虑到患者一般状况和精神状态不佳，手术治疗被认为困难，并于当天对右眼行玻璃体腔内注射 0.1ml 浓度为 1.25%的聚维酮碘。炎症迅速消退，治疗后 4 天前房积脓消失。治疗后 7 天眼底可见，眼内炎无复发。右眼视力恢复至与左眼相同（0.2）。
玻璃体腔内注射聚维酮碘作为内源性眼内炎患者替代抗生素治疗的方法具有潜在的有效性，尤其适用于手术治疗困难的患者。
