Pandit Kamal, Khatri Anadi, Sitaula Sanjeeta, Kharel Sitaula Ranju, Shrestha Gulshan Bahadur, Joshi Sagun Narayan, Karki Pratap, Rai Pravin, Chaudhary Meenu
Department of Ophthalmology, B.P Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.
Department of Retina and Uvea, Birat Eye Hospital, Biratnagar, Nepal.
Ann Med Surg (Lond). 2022 May 2;77:103692. doi: 10.1016/j.amsu.2022.103692. eCollection 2022 May.
Intraocular foreign bodies (IOFBs) can be serious as they may result in vision-threatening ocular inflammations and even loss of the eye. Delay in presentation or treatment by more than 24 hours from the time of injury results in a poor prognosis. In penetrating wounds, microorganisms enter the eye through penetrating objects. Both bacterial and fungal organisms are responsible for causing panophthalmitis. At the ocular level, these microorganisms produce irreversible damage which includes keratitis, uveitis, hypopyon, vitreous abscesses, retinal necrosis, detachment, and, finally, panophthalmitis.
In this case series, we report three cases of IOFB presenting with panophthalmitis secondary to delay in seeking medical attention. In our cases, there was a delay in the presentation by more than 24 hours of trauma. All cases had panophthalmitis at the time of presentation. In two cases, the causative organism was coagulase-negative staphylococci and in one case it was staphylococcus. Initially, we planned to manage them with intravitreous, intravenous and topical antibiotics till the inflammation subsides, then IOFB removal surgeries were planned. However, in two cases, the clinical presentation worsens with scleral necrosis. Therefore, they had to undergo evisceration. In one case, the antibiotics therapy was enough without IOFB removal surgery to manage her symptoms. All cases recovered uneventfully after the interventions.
DISCUSSION/CONCLUSION: In developing nations, like Nepal, transportation barriers can affect a person's access to health care services. This can be clearly explained from this case series as limited transportation options in rural regions are a major factor for all patients' delayed presentation to the hospital during the time of national lockdown in the second wave of the COVID-19 pandemic. The concerned authority must pay attention to solving such social determinants of health.
眼内异物（IOFBs）可能很严重，因为它们可能导致威胁视力的眼部炎症，甚至失明。受伤后就诊或治疗延迟超过24小时会导致预后不良。在穿透性伤口中，微生物通过穿透物体进入眼睛。细菌和真菌都可导致全眼球炎。在眼部层面，这些微生物会造成不可逆转的损害，包括角膜炎、葡萄膜炎、前房积脓、玻璃体脓肿、视网膜坏死、脱离，最终导致全眼球炎。
在本病例系列中，我们报告了3例因延误就医而继发全眼球炎的眼内异物病例。在我们的病例中，受伤后就诊延迟超过24小时。所有病例就诊时均患有全眼球炎。2例的致病微生物为凝固酶阴性葡萄球菌，1例为葡萄球菌。最初，我们计划用玻璃体内、静脉内和局部抗生素治疗，直到炎症消退，然后计划进行眼内异物取出手术。然而，2例的临床表现因巩膜坏死而恶化。因此，他们不得不接受眼球摘除术。1例中，抗生素治疗足以控制症状，无需进行眼内异物取出手术。所有病例在干预后均顺利康复。
讨论/结论：在尼泊尔等发展中国家，交通障碍会影响人们获得医疗服务的机会。从这个病例系列中可以清楚地看出，在第二波新冠疫情全国封锁期间，农村地区有限的交通选择是所有患者延迟就医的主要因素。有关当局必须重视解决此类健康的社会决定因素。
