Morris Robert E, Saini Vikram T, Tosi Nicholas, Kuhn Ferenc, Sapp Mathew R, Oltmanns Matthew H
Retina Specialists of Alabama, LLC, Birmingham, Alabama, USA.
Helen Keller Foundation for Research and Education, Birmingham, Alabama, USA.
Eur J Ophthalmol. 2025 Mar;35(2):NP49-NP54. doi: 10.1177/11206721241297186. Epub 2024 Nov 6.
Intraocular foreign bodies (IOFBs) are known to cause endophthalmitis at a high rate. Media opacity (corneal edema, cataract, vitreous hemorrhage) and the need for diagnostic testing often prevent timely recognition of an infection; the resulting treatment delay worsens the prognosis. We present a case in which direct visualization of a posterior-segment IOFB and the incipient endophthalmitis allowed foregoing further testing (computed tomography), shortening the time to sight-saving vitrectomy.
A 16-year-old male presented 19 h after a hammering-related injury. The media remained clear, permitting recognition of a large area of purulent retinal infiltrate adjacent to the intravitreal IOFB. Within one hour the patient underwent comprehensive surgery (wound closure, vitrectomy, IOFB removal, and intravitreal antibiotic injection). The development of full-blown endophthalmitis was prevented, even though the vitreous culture yielded . Final visual acuity at one year was 20/30, with the retinal injury approaching to within 1 mm of the fovea.
In opaque-media eyes with a suspected IOFB treatment delay is common, due to waiting for computed tomography (CT) - instead of ultrasonography, which can safely identify the IOFB in over 90% of cases. Expediting surgery is the best prophylaxis against post-presentation endophthalmitis. Our case highlights the benefits of early vitrectomy based on direct inspection of the IOFB alone; instant ultrasonography instead of a CT-caused delay may save eyes with infection developing behind media opacity.
眼内异物（IOFBs）已知会导致高发生率的眼内炎。介质混浊（角膜水肿、白内障、玻璃体出血）以及诊断测试的需求常常阻碍对感染的及时识别；由此导致的治疗延迟会使预后恶化。我们报告一例病例，其中后段眼内异物及初期眼内炎的直接可视化使得无需进一步检查（计算机断层扫描），从而缩短了进行挽救视力的玻璃体切除术的时间。
一名16岁男性在与锤击相关的损伤后19小时就诊。介质保持清晰，使得能够识别与玻璃体内眼内异物相邻的大面积脓性视网膜浸润。患者在一小时内接受了全面手术（伤口闭合、玻璃体切除术、眼内异物取出及玻璃体内抗生素注射）。尽管玻璃体培养结果为[此处原文缺失具体结果]，但仍预防了严重眼内炎的发生。一年后的最终视力为20/30，视网膜损伤距离黄斑中心凹不到1毫米。
在怀疑有眼内异物的介质混浊眼中，由于等待计算机断层扫描（CT）而非超声检查（超声检查在超过90%的病例中能安全识别眼内异物），治疗延迟很常见。加快手术是预防就诊后眼内炎的最佳措施。我们的病例突出了仅基于对眼内异物的直接检查进行早期玻璃体切除术的益处；即时超声检查而非CT导致的延迟可能挽救在介质混浊后发生感染的眼睛。
