Weissgold D J, Maguire A M, Brucker A J
Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Ophthalmology. 1996 May;103(5):749-56. doi: 10.1016/s0161-6420(96)30620-9.
Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by Acremonium kiliense with in vitro sensitivity to amphotericin B. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin B injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations.
The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin B, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients for management of either primary (1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens.
Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin B. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin B injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin B. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms.
Single-dose administration of intravitreous amphotericin B was inadequate treatment for fungal endophthalmitis caused by A. kiliense. Vitrectomy with repeated intravitreous administration of amphotericin B may be necessary to eradicate intraocular function caused by this organism.
4例患者在白内障手术后出现由基内枝顶孢霉引起的迟发性眼内炎，该菌对两性霉素B体外敏感。所有患者的眼部感染对单剂量玻璃体内注射两性霉素B均无反应。作者回顾了由基内枝顶孢霉引起的眼内炎的治疗情况并提出了治疗建议。
作者回顾性评估了4例白内障超声乳化联合后房型人工晶状体植入术后发生迟发性术后眼内炎的患者。所有患者均进行了玻璃体采样、玻璃体内注射两性霉素B以及全身性给予氟康唑。所有患者均接受了玻璃体切割术以处理原发性感染（1只眼）或持续性感染（3只眼）。2例持续性感染患者还对其眼内后房型人工晶状体进行了手术检查。
3只接受了玻璃体抽吸并玻璃体内注射5微克两性霉素B的眼中，有3只眼感染恶化。这些患者随后对玻璃体切割术以及额外的玻璃体内注射两性霉素B产生了反应。1只眼接受了原发性玻璃体切割术并玻璃体内注射了7.5微克两性霉素B。尽管初始感染的治疗取得了成功，但该患者在就诊3个月后发生了真菌性角膜炎。视力结果各异，随访2年期间，视力从20/25到无光感不等。流行病学调查提示基内枝顶孢霉的传染源为共同的环境来源。
单剂量玻璃体内注射两性霉素B不足以治疗由基内枝顶孢霉引起的真菌性眼内炎。可能有必要进行玻璃体切割术并反复玻璃体内注射两性霉素B以根除该病原体引起的眼内感染。
