人工水晶体移植術後のProteus mirabilisによる眼内炎の1例

A case of endophthalmitis due to Proteus mirabilis following intraocular lens implantation

　人工水晶体挿入2日後にProteus mira-bilisによる眼内炎を起こした84歳男性の症例を報告した．発症日に，人工水晶体摘出とCefazolinによる前房洗浄を施行．次いで，TobramycinとCefazolin,CephalexinまたはLatamoxefの点滴静注，およびTobramycinまたはGentamicinの結膜下注射を行い，眼内細菌は陰性となった．この時点からステロイド剤を投与し，角膜の透明化，前房内滲出物の吸収に成功した．

　Tobramycin 60mg点滴静注直後の血清TOB濃度は2.16〜7.18μg／ml，静注4.5時間後の前房水中Tobramycin濃度は1.2μg／mlであった．房水中の最高Tobramycin濃度はもっと高値であったと推定され，Proteus mirabilisの殺菌作用に十分な濃度であったと考えられる．

An 84-year-old male underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation in his right eye. Signs of endophthalmitis became manifest 2 days after surgery. We treated the case with removal of IOL and irrigation of the anterior chamber with cef-azolin solution. Culture of anterior aqueous humor showed the presence of Proteus mirabilis.

The infection was successfully treated with sys-temic tobramycin, cefazolin, cefotaxime and latamoxef and with topical tobramycin and gentamicin. The serum and aqueous levels of to-bramycin ranged between 2.16 and 7.18 μg/ml for the serum and 1.2 μg/ml for the aqueous after a single intravenous administration of 60mg of to-bramycin. These levels were thought to be bacter-iocidal for Proteus mirabilis.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(3) : 251-254, 1987