Kayazawa Mariko, Kodama-Takahashi Aya, Sugioka Koji, Yunoki Mai, Kusaka Shunji
Department of Ophthalmology, Kindai University Nara Hospital, Ikoma, Japan.
Department of Ophthalmology, Kindai University Faculty of Medicine, Osakasayama, Japan.
Case Rep Ophthalmol. 2024 Sep 30;15(1):696-702. doi: 10.1159/000541163. eCollection 2024 Jan-Dec.
This report describes a case of necrotizing scleritis caused by infection soon after vitreous surgery, which caused severe scleral melting and rapidly progressive necrosis that led to scleral perforation and bacterial endophthalmitis.
The patient was an 86-year-old man with a history of type 2 diabetes mellitus who underwent pars plana vitrectomy (PPV) for vitreous hemorrhage in his right eye. On postoperative day 10, he complained of severe ocular pain and was found to have conjunctival edema and eyelid swelling, which was treated by topical and general systemic antibiotics. His ocular symptoms improved but subsequently worsened. On postoperative day 25, hypopyon and a fibrinous exudative membrane were observed in the anterior chamber, and the fundus could not be visualized. PPV was repeated with addition of silicone oil tamponade. During the surgery, the retina was found to be completely detached with severe anterior scleral melting, perforation, and necrosis, as well as abscess formation. Culture of an eye discharge specimen detected . After surgery, antibiotics were administered and the eye was washed with polyvinyl alcohol-iodine solution daily. Ten days later, the eye pain and eyelid swelling were significantly improved. The scleral inflammation gradually resolved without recurrence.
In this case, rapidly progressive necrotizing scleritis caused by infection was controlled by a combination of antibiotics, removal of necrotic tissue, and daily eye washing with polyvinyl alcohol-iodine solution.
本报告描述了一例玻璃体切除术后不久因感染引起的坏死性巩膜炎病例，该感染导致严重的巩膜溶解和快速进展的坏死，进而导致巩膜穿孔和细菌性眼内炎。
患者为一名86岁男性，有2型糖尿病病史，因右眼玻璃体积血接受了玻璃体切除手术。术后第10天，他主诉眼部剧痛，检查发现有结膜水肿和眼睑肿胀，给予局部和全身抗生素治疗。他的眼部症状有所改善，但随后又恶化。术后第25天，前房出现前房积脓和纤维蛋白渗出膜，眼底无法看清。遂再次进行玻璃体切除术并加用硅油填塞。手术中发现视网膜完全脱离，伴有严重的前部巩膜溶解、穿孔和坏死，以及脓肿形成。眼部分泌物标本培养检测到……。术后给予抗生素治疗，每天用聚乙烯醇碘溶液冲洗眼睛。10天后，眼痛和眼睑肿胀明显改善。巩膜炎症逐渐消退，未复发。
在本病例中，由……感染引起的快速进展性坏死性巩膜炎通过联合使用抗生素、清除坏死组织以及每天用聚乙烯醇碘溶液冲洗眼睛得到了控制。
