Okonkwo Ogugua Ndubuisi, Sibanda Dennis, Akanbi Toyin, Hassan Adekunle Olubola
Eye Foundation Retina Institute, 27 Isaac John Street, Lagos, Nigeria.
Eye Foundation Hospital, Apo Legislative Quarters, Abuja, Nigeria.
Am J Ophthalmol Case Rep. 2020 Oct 20;20:100977. doi: 10.1016/j.ajoc.2020.100977. eCollection 2020 Dec.
To report the successful treatment of post intravitreal bevacizumab recurrent Burkholderia cepacia endophthalmitis managed with a clear lens extraction and posterior capsulectomy.
A 34-year-old female African, known SC hemoglobinopathy patient, presented with bilateral blur in vision and floaters of a week duration; worse in her right eye. Her visual acuity was right eye 6/9 (20/30) and left eye 6/6 (20/20). Her anterior segment examination was normal in both eyes. On fundus examination, she had a right eye vitreous hemorrhage and bilateral active Sea-fan neovascular proliferation in the retina periphery. Following the administration of bilateral simultaneous intravitreal bevacizumab, she presented 4 days later with a right eye infective endophthalmitis. She suffered multiple recurrences despite adequate treatment, including a vitrectomy with silicone oil injection. Multiple microbiological assessment of intraocular extracts confirmed persistent Burkholderia cepacia infection. A wide ring-shaped opaque plaque was noticed on the posterior capsule of her clear lens. A decision was taken to perform a lensectomy and posterior capsulectomy. This resulted in immediate resolution of hypopyon and all intraocular inflammation. Vision improved from Hand Motion to 6/18 (20/60).
This report suggests than in some cases of recurrent, difficult to treat, Burkholderia cepacia endophthalmitis, since the organism may have colonized the posterior lens capsule, the eye and vision can be salvaged by timely removal of a clear lens and capsulectomy. Clear lens removal has not been previously reported for treating recurrent Burkholderia cepacia endophthalmitis.
报告通过透明晶状体摘除术和后囊切开术成功治疗玻璃体内注射贝伐单抗后复发性洋葱伯克霍尔德菌眼内炎的病例。
一名34岁的非洲女性，已知患有镰状细胞血红蛋白病，出现双侧视力模糊和飞蚊症，持续一周，右眼症状更严重。她的视力右眼为6/9（20/30），左眼为6/6（20/20）。双眼前段检查正常。眼底检查发现，她右眼玻璃体出血，双眼视网膜周边有活跃的海扇状新生血管增殖。双侧同时玻璃体内注射贝伐单抗4天后，她出现了右眼感染性眼内炎。尽管进行了充分治疗，包括玻璃体切除术联合硅油注射，但她仍多次复发。对眼内提取物进行的多次微生物学评估证实存在持续性洋葱伯克霍尔德菌感染。在她透明晶状体的后囊上发现了一个宽环形不透明斑块。决定进行晶状体切除术和后囊切开术。这立即导致了前房积脓和所有眼内炎症的消退。视力从手动提高到6/18（20/60）。
本报告表明，在一些复发性、难以治疗的洋葱伯克霍尔德菌眼内炎病例中，由于该病原体可能已定植于晶状体后囊，及时摘除透明晶状体和进行囊切开术可挽救眼球和视力。此前尚未有关于通过摘除透明晶状体治疗复发性洋葱伯克霍尔德菌眼内炎的报道。
