Zaslavsky Kirill, Grewal Parampal S, Cruz-Pimentel Miguel, Qian Jenny, Derzko-Dzulynsky Larissa, Yan Peng
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Retin Cases Brief Rep. 2024 Jan 1;18(1):71-76. doi: 10.1097/ICB.0000000000001306.
The purpose of this study was to describe a case of endogenous endophthalmitis (EE) after severe COVID-19 disease, review patient outcomes with EE after COVID-19 infection, and review evidence regarding risk factors for developing EE.
This is a review of health records, imaging, intravitreal injection, and pars plana vitrectomy for bilateral fungal EE after severe COVID-19 disease, and is a literature review on outcomes in EE after COVID-19 disease.
Sixty-three year-old man with diabetes and hypertension was admitted to hospital for severe COVID-19 disease for 3 months. His stay required intensive care unit admission, intubation, high-dose corticosteroids, tocilizumab, and was complicated by bacteremia, empyema, and fungal esophagitis. He developed floaters and bilateral vision loss (visual acuity 20/40 in the right eye, counting fingers in the left eye) with vitritis 2.5 months into his stay that did not respond to intravitreal voriconazole. Pars plana vitrectomy was performed for both eyes, resulting in visual acuity of 20/40 in the right eye, 20/30 in the left eye. Vitreous cultures were positive for Candida albicans . Endogenous endophthalmitis after COVID-19 disease has been reported in 22 patients to date, and outcomes are poor, with 40%+ of eyes legally blind (20/200 or worse). Although influenced by availability of imaging modalities and degree of training of the evaluating physician, misdiagnosis can affect ¼ of cases, delaying treatment. Age, male sex, and diabetes increase the risk of severe COVID-19, which requires prolonged hospitalization, invasive catheterization, and immunosuppression, which in turn increases the risk of nosocomial infection.
Low threshold for suspecting EE in patients presenting with floaters and decreased vision after severe COVID-19 disease is necessary to ensure prompt recognition and treatment.
本研究旨在描述1例重症新型冠状病毒肺炎（COVID-19）后发生的内源性眼内炎（EE）病例，回顾COVID-19感染后EE患者的预后情况，并综述发生EE的危险因素相关证据。
这是一项对1例重症COVID-19疾病后双侧真菌性EE患者的健康记录、影像学检查、玻璃体内注射及玻璃体切割术的回顾，也是一项关于COVID-19疾病后EE预后情况的文献综述。
一名63岁患有糖尿病和高血压的男性因重症COVID-19疾病入院3个月。住院期间，他需要入住重症监护病房、进行插管、使用大剂量皮质类固醇和托珠单抗治疗，还并发了菌血症、脓胸和真菌性食管炎。住院2.5个月时，他出现了飞蚊症和双侧视力下降（右眼视力20/40，左眼仅能数指），伴有玻璃体炎，玻璃体内注射伏立康唑治疗无效。对双眼进行了玻璃体切割术，术后右眼视力为20/40，左眼视力为20/30。玻璃体培养白色念珠菌呈阳性。截至目前，已有22例患者被报道在COVID-19疾病后发生内源性眼内炎，预后较差，超过40%的患眼视力法定盲（20/200或更差）。尽管受影像学检查手段的可及性和评估医生的培训程度影响，但误诊仍可能影响四分之一的病例，从而延误治疗。年龄、男性及糖尿病会增加发生重症COVID-19的风险，而重症COVID-19需要长期住院、侵入性导管插入术及免疫抑制治疗，这反过来又增加了医院感染的风险。
对于重症COVID-19疾病后出现飞蚊症和视力下降的患者，有必要提高对EE的怀疑阈值，以确保及时识别和治疗。
