胆管炎で発症し胆管炎の再発により再発した内因性細菌性眼内炎の1例

A case of endogenous bacterial endophthalmitis occurring and recurring after episodes of choloangiitis

要約　目的：原疾患の再発時に内因性細菌性眼内炎（EBE）が再発した症例の報告。

症例：73歳の糖尿病合併男性。胆管炎治療中に右眼視力が0.02に低下し，充血，前房蓄膿，硝子体混濁を認めた。EBEとして緊急に前房洗浄，水晶体・硝子体切除を行った。術中に大型の網膜滲出壊死巣が認められた。術後に前房洗浄を追加し，肺炎桿菌が分離された。以後の経過は良好で，3か月後眼内レンズを移植し，視力0.8を得た。その1か月後の胆管炎再発に伴いEBEが再発し，この硝子体手術時に眼底への大量の膿付着と網膜出血を認めた。その後も2回硝子体手術を追加して消炎し，最終視力は0.3であった。

結論：EBE治療には初発再発を問わず消炎を得るまで硝子体手術を施行する必要がある。

Abstract　Purpose: To report a case of endogenous bacterial endophthalmitis that occurred and recurred after episodes of choloangiitis.

Case: A 73-year-old male was referred to us for impaired vision in the right eye. He had been treated for acute cholangiitis since 5 days before. Klebsiella pneumonia and Escherichia coli were isolated from the bile and venous blood. He had also long-standing diabetes mellitus.

Findings: Corrected visual acuity was 0.02 right and 1.0 left. The right eye showed hypopyon and vitreous opacity. He was diagnosed with endogenous bacterial endophthalmitis and was treated by anterior chamber irrigation, lensectomy, and vitrectomy. As intraoperative finding, the retina showed large exudative and necrotic lesion. Klebsiella pneumoniae was isolated from the aqueous humor. Visual acuity improved to 0.8 after surgery. Cholangiitis recurred 4 months after the initial episode. Right vision started to deteriorate 5 days later followed by recurrence of endophthalmitis. Vitrectomy showed massive putrid mass adherent to the fundus. Final vision of 0.3 resulted after two additional sessions of surgery.

Conclusion: Repetition of vitrectomy until the subsiding of the inflammation plays a vital role in treating endogenous bacterial endophthalmitis of both the first and the second episodes.