Asian Eye Institute, Makati, Philippines.
J Glaucoma. 2020 Oct;29(10):e110-e112. doi: 10.1097/IJG.0000000000001617.
The purpose of this study was to report a rare case of late-onset subconjunctival abscess associated with an unexposed Ahmed glaucoma valve implant secondary to Serratia marcescens, a rare conjunctival pathogen.
Case description including clinical imaging and literature review of glaucoma drainage device (GDD)-related infections.
A 73-year-old man presented with blurring of vision, redness, and pain on his right eye 2 months after Ahmed glaucoma valve implantation for advanced postpenetrating-keratoplasty glaucoma. The patient was nonsmoker, had fairly controlled type 2 diabetes mellitus on insulin, and had undergone multiple eye surgeries on the right eye. On ocular examination, the conjunctiva was injected with fairly delineated yellowish-white subconjunctival material in the superotemporal quadrant with no associated tube exposure or leak, and the anterior chamber was quiet. The patient was assessed with Ahmed glaucoma valve infection with subconjunctival abscess and was treated by Ahmed glaucoma valve explant with directed systemic and topical antimicrobial therapy. The culture and sensitivity results revealed S. marcescens sensitive to ciprofloxacin, ceftazidime, gentamicin, and amikacin. Despite the virulence of the pathogen, the eye was saved.
Ahmed glaucoma valve infection with subconjunctival abscess secondary to S. marcescens is rare. GDD-related infections should be suspected in patients presenting with blurring of vision, pain, and redness even in the absence of tube exposure. Early diagnosis and treatment with culture-guided antimicrobial therapy combined with GDD explant is fundamental in optimizing the visual outcome.
本研究旨在报告一例罕见的迟发性结膜下脓肿病例，该脓肿与暴露型 Ahmed 青光眼引流阀植入术后继发于粘质沙雷氏菌（一种罕见的结膜病原体）感染相关。
包括临床影像学检查在内的病例描述，并对青光眼引流装置（GDD）相关感染进行文献复习。
一名 73 岁男性，因穿透性角膜移植术后晚期青光眼行 Ahmed 青光眼引流阀植入术后 2 个月出现视力模糊、眼红和右眼疼痛。患者不吸烟，患有 2 型糖尿病，使用胰岛素控制，且右眼已接受多次手术。眼部检查发现，结膜呈中度充血，上颞象限有界限分明的淡黄色结膜下物质，无引流管外露或渗漏，前房无积脓。患者被诊断为 Ahmed 青光眼引流阀感染合并结膜下脓肿，并接受 Ahmed 青光眼引流阀取出术，同时给予全身和局部抗感染治疗。培养和药敏结果显示粘质沙雷氏菌对环丙沙星、头孢他啶、庆大霉素和阿米卡星敏感。尽管该病原体具有很强的毒性，但该眼得以保留。
继发于粘质沙雷氏菌的 Ahmed 青光眼引流阀感染合并结膜下脓肿较为罕见。即使无引流管外露，出现视力模糊、疼痛和眼红的患者也应怀疑 GDD 相关感染。早期诊断和基于培养的抗感染治疗联合 GDD 取出术对于优化视力预后至关重要。
