Kim Tae-Hoon, Lee Sang-Joon, Nam Ki-Yup
Department of Ophthalmology, Kosin University Hospital, Busan 49267, South Korea.
Department of Ophthalmology, Kosin University, College of Medicine, Busan 49267, South Korea.
World J Clin Cases. 2022 Jul 6;10(19):6496-6500. doi: 10.12998/wjcc.v10.i19.6496.
species-associated endophthalmitis is rare and may present as either acute or chronic postoperative endophthalmitis. Delayed-onset species endophthalmitis appearing in acute presentation that develops more than several months after cataract surgery is very rare. Intraocular lens (IOL) removal is commonly recommended to treat species endophthalmitis, which is based on previous studies. Here, we report the results of surgery without IOL removal when treating patients with delayed-onset postoperative species endophthalmitis that developed in an acute form.
Three patients visited our ophthalmology clinic due to visual impairment that began 2-3 d earlier. They had undergone cataract surgery 5-18 mo prior. Best-corrected visual acuity of the diseased eye was between counting fingers at 30 cm to non-light perception. They showed conjunctival injection, inflammation in the anterior chamber (cell reaction 4+) and hypopyon formation. The patients were diagnosed with infectious endophthalmitis and immediately underwent pars plana vitrectomy, anterior chamber irrigation and intravitreal injection of ceftazidime and vancomycin. Before fluid infusion, a vitreous specimen was obtained. In all cases, the IOLs were not removed. species was detected on vitreous specimen culture. After surgery, the vitreous opacity decreased gradually and there was little retinal damage. At 1 mo after treatment, the best-corrected visual acuity had improved to 20/50 and 20/40.
Delayed onset postoperative endophthalmitis caused by species can appear in an acute form. All patients responded well to early vitrectomy and administration of empirical antibiotics including ceftazidime. There was no need for IOL removal during surgery.
与特定菌种相关的眼内炎较为罕见，可表现为急性或慢性术后眼内炎。白内障手术后数月以上出现的急性表现的迟发性特定菌种眼内炎非常罕见。根据以往研究，通常建议摘除人工晶状体（IOL）来治疗特定菌种眼内炎。在此，我们报告了在治疗以急性形式发生的迟发性术后特定菌种眼内炎患者时不摘除IOL的手术结果。
三名患者因2 - 3天前开始的视力障碍前来我们的眼科诊所就诊。他们在5 - 18个月前接受了白内障手术。患眼的最佳矫正视力在30厘米数指至无光感之间。他们表现出结膜充血、前房炎症（细胞反应4 +）和前房积脓形成。患者被诊断为感染性眼内炎，并立即接受了玻璃体切割术、前房冲洗以及玻璃体内注射头孢他啶和万古霉素。在输液前，获取了玻璃体标本。在所有病例中，均未摘除IOL。玻璃体标本培养检测到特定菌种。手术后，玻璃体混浊逐渐减轻，视网膜损伤很小。治疗1个月后，最佳矫正视力提高到了20/50和20/40。
由特定菌种引起的迟发性术后眼内炎可呈急性形式出现。所有患者对早期玻璃体切割术和给予包括头孢他啶在内的经验性抗生素反应良好。手术期间无需摘除IOL。
