硝子体手術およびアンフォテリシンB硝子体内注入の著効した内因性Candida albicans眼内炎の1例

Successful treatment of Candida albicans endophthalmitis with vitrectomy and intravitreal amphotericin B

　胃亜全摘術，経中心静脈高カロリー輸液施行後，内因性真菌性眼内炎をきたした症例にたいし，硝子体手術，アンフォテリシンB硝子体内注入を施行し，良好な視力予後を得た．

　本症例は，除去した硝子体の真菌培養によりCandida albicans眼内炎と診断された．また抗真菌剤の全身投与は施行せずに眼内炎は治癒し，術後1,5年の間再発をみていない．

　保存的療法のみでの治療が困難な重症内因性真菌性眼内炎に対する，硝子体手術とアンフォテリシンBの硝子体内注入は有効な治療法であると考えられた．

A 35-year-old male developed bilateral endophth-almitis 5 weeks after subtotal gastrectomy for stomach carcinoma. The endophthalmitis subsided initially but flared up 3 months later with the left eye vision reduced to counting fingers.

We treated the left eye by pars plana vitrectomy. The vitreous cavity was irrigated with a solution containing amphotericin B (1μg ml) and Gentamicin (10 mg/500 ml).

The diagnosis of Candida albicans infection was suspected on clinical features and was confirmed by culture of vitreous aspirate obtained during vitrectomy. While antifungal agents were not used, the intraocular infection rapidly cleared up after surgery. The visual acuity ultimately returned to 0.4.

This case illustrates that the combination of vitrectomy with irrigation of the vitreous with antifungal agents can cure candida albicans endo-phthalmitis and preserve useful vision.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(5) : 541-545, 1987