Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana.
Retin Cases Brief Rep. 2024 May 1;18(3):296-300. doi: 10.1097/ICB.0000000000001398.
To report the use of a subtenon's vancomycin injection for the treatment of subretinal abscess secondary to methicillin-resistant Staphylococcus aureus endogenous endophthalmitis.
A 17-year-old man developed endogenous endophthalmitis with subretinal abscess in his right eye secondary to methicillin-resistant Staphylococcus aureus bacteremia from axillary necrotizing fasciitis. Despite prompt treatment with IV vancomycin and an intravitreal vancomycin injection, the patient displayed minimal improvement. The patient was subsequently treated with a subtenon's vancomycin injection. The injection technique is described in detail, as well as a review of the treatment options available for bacterial subretinal abscesses.
On presentation, examination revealed minimal vitritis and a large yellow subretinal abscess superotemporally extending close to the macula with subretinal fluid inferotemporally involving the macula. Four days postintravitreal vancomycin injection, the abscess remained stable and the patient developed an exudative detachment temporally. Vancomycin was injected superotemporally in the subtenon's space with no complications during the procedure or during his postoperative recovery. At seven days postinjection, the subretinal abscess and exudative retinal detachment resolved completely with necrosis at the area of previous abscess.
We present the first successful case of subtenon's vancomycin injection for the treatment of bacterial subretinal abscess. Our case demonstrates that subtenon's injection of antibiotics is a safe and effective nonsurgical management option for bacterial subretinal abscesses.
报告使用经Tenon 囊下注射万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）内源性眼内炎引起的视网膜下脓肿。
一名 17 岁男性因右侧腋窝坏死性筋膜炎合并甲氧西林耐药金黄色葡萄球菌菌血症，引发内源性眼内炎和视网膜下脓肿。尽管及时给予静脉万古霉素和玻璃体内万古霉素注射治疗，但患者的病情仅有轻微改善。随后，患者接受了经Tenon 囊下注射万古霉素治疗。详细介绍了注射技术，并对细菌性视网膜下脓肿的治疗选择进行了综述。
就诊时，检查发现轻微的玻璃体炎症和一个大的黄色视网膜下脓肿，位于上方颞侧，靠近黄斑，下方颞侧有视网膜下积液累及黄斑。玻璃体内注射万古霉素后 4 天，脓肿仍稳定，但患者颞侧出现渗出性脱离。在 Tenon 囊下空间进行了万古霉素的上方颞侧注射，在手术过程中和术后恢复期间均无并发症。注射后 7 天，视网膜下脓肿和渗出性视网膜脱离完全消退，先前脓肿部位出现坏死。
我们首次成功报告了经 Tenon 囊下注射万古霉素治疗细菌性视网膜下脓肿的病例。我们的病例表明，经 Tenon 囊下注射抗生素是治疗细菌性视网膜下脓肿的一种安全有效的非手术治疗选择。
