Fekrat S, Haller J A, Green W R, Gottsch J D
Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD 21287-9248, USA.
Cornea. 1995 Mar;14(2):212-6.
We describe a case of Candida parapsilosis endophthalmitis with a consecutive keratitis after phacoemulsification and posterior chamber intraocular lens implantation in an otherwise healthy eye. Despite aggressive medical and surgical management during a 2-year period, multiple episodes recurred, with the development of an intracapsular plaque and an infectious nidus on the corneal endothelium 6 months after the initial presentation. After subtotal removal of the culture-positive capsule, intravitreal and topical amphotericin B, and oral fluconazole, the inflammation improved. However, the corneal endothelial plaque persisted with recurrent inflammation 2 months later, prompting debridement of the culture-positive plaque and further removal of the culture-negative capsular remnants and lens implant. The infection was quiescent for the subsequent 12-month period until recurrent intraocular inflammation developed with enlargement of the endothelial plaque. Culture of this plaque was again positive for C. parapsilosis. After debridement and intraocular and topical amphotericin B, the eye has now been quiescent for 13 months. This case demonstrates the development of a secondary keratitis in an eye affected by pseudophakic C. parapsilosis endophthalmitis, with the posterior cornea serving as a sanctuary site for the fungus despite aggressive management leading to recurrent infection 1 year after the clinical disease appeared to be quiescent.
我们描述了一例近平滑念珠菌性眼内炎病例，该病例发生在一只原本健康的眼睛进行白内障超声乳化吸除及后房型人工晶状体植入术后，并继发了角膜炎。尽管在两年时间里采取了积极的药物和手术治疗措施，但仍多次复发，在初次发病6个月后出现了囊内斑块以及角膜内皮上的感染病灶。在对培养阳性的囊膜进行大部分切除、玻璃体内及局部应用两性霉素B以及口服氟康唑后，炎症有所改善。然而，两个月后角膜内皮斑块持续存在并伴有炎症复发，促使对培养阳性的斑块进行清创，并进一步切除培养阴性的囊膜残余物和晶状体植入物。在随后的12个月里感染处于静止状态，直到再次出现眼内炎症且内皮斑块增大。该斑块培养再次显示近平滑念珠菌阳性。在进行清创以及玻璃体内和局部应用两性霉素B后，这只眼睛目前已静止13个月。该病例表明，在假晶状体性近平滑念珠菌性眼内炎的患眼中会发生继发性角膜炎，尽管积极治疗使临床疾病在看似静止1年后仍出现反复感染，但后角膜成为了真菌的庇护场所。
