Neyaz Hanan A, AlGhamdi Ismail, A Alsadhan Ghadh, Alkharashi Maan S
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Ophthalmology, Ohud Hospital, Madinah, Saudi Arabia.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2024 Jul;120:109850. doi: 10.1016/j.ijscr.2024.109850. Epub 2024 Jun 1.
After strabismus surgery, infections and complications are uncommon but avoidable with the right aseptic measures. Rarely have cases of non-infectious sub-tenon abscesses been documented in the past; these cases need to be appropriately recognized and treated.
In this report we describe a case of bilateral sub-tenon abscess 4 weeks after medial rectus recession. Despite receiving topical antibiotics for 7 days, there was no improvement, and multiple conjunctival cultures and sensitivity showed no growth. Both eye's sub-tenon abscess was drained, irrigated with gentamicin, and the fragile suture was removed.
Sub-tenon abscess has been associated with bacterial infection which has more sever presentation. Several facts, including the lack of organisms in the pre-operative and intraoperative cultures, the presence of big cells resembling foreign bodies, and the improvement that occurred after suture extrusion, make infection unlikely in this case.
We concluded that suture reaction is most likely to be responsible for a late-onset sub-tenon abscess with a negative culture and no response to antibiotics, and the suture should be removed.
斜视手术后,感染和并发症并不常见,但采取正确的无菌措施是可以避免的。过去很少有非感染性眼球筋膜下脓肿的病例记录;这些病例需要得到恰当的识别和治疗。
在本报告中,我们描述了一例在内直肌后徙术后4周出现双侧眼球筋膜下脓肿的病例。尽管使用局部抗生素治疗了7天,但病情并无改善,多次结膜培养及药敏试验均未发现细菌生长。对双眼的眼球筋膜下脓肿进行了引流,用庆大霉素冲洗,并拆除了脆弱的缝线。
眼球筋膜下脓肿与细菌感染有关,细菌感染的表现更为严重。包括术前和术中培养未发现细菌、存在类似异物的大细胞以及缝线拆除后病情好转等几个事实,表明该病例不太可能是感染。
我们得出结论,缝线反应最有可能是导致培养阴性且对抗生素无反应的迟发性眼球筋膜下脓肿的原因,应拆除缝线。