25G小切開硝子体切除術後低眼圧を伴い眼内炎に至った1例

A case of endophthalmitis following ocular hypotension after 25-gauge microincision vitrectomy

要約　目的：硝子体出血に対する硝子体手術後に感染性眼内炎を発症した症例の報告。

症例：55歳の女性が左眼視力低下で受診した。矯正視力は右1.2，左20cm指数弁で，左眼に硝子体出血があった。1週後に3ポート25Gシステムでの硝子体手術を行った。網膜周辺部2時の部位に網膜裂孔があり，光凝固で処理した。漏出のある強膜創1か所を縫合した。手術時間は48分であった。翌日の眼圧は4mmHgで，翌々日に眼痛と霧視が生じ，前房蓄膿があった。術後眼内炎と診断し，硝子体切除と水晶体乳化吸引を行い，眼内レンズは挿入しなかった。前回無縫合の強膜創1か所に付着物があった。複数の抗菌薬を局所と全身投与し，14日後に視力は0.9に改善した。

結論：小切開であっても硝子体手術後に眼内感染が生じることがあり，縫合または液空気置換が推奨される。

Abstract　Purpose: To report a case who received 25-gauge microincision vitrectomy and who developed endophthalmitis with ocular hypotension.

Case: A 55-year-old female presented with impaired vision in the left eye. Corrected visual acuity was 1.2 right and counting fingers left. The left eye showed vitreous hemorrhage. She received 25-gauge microincision vitrectomy one week later. A retina tear was detected during surgery and was treated by photocoagulation. One scleral wound showed leakage and was closed by suture. The whole surgery lasted 48 minutes. The left eye showed intraocular pressure of 4 mmHg the following day. Hyphema with ocular pain developed one day layer. The left eye was diagnosed with endophthalmitis and received vitrectomy and phacoemulsification-aspiration. One of the scleral wounds that had received no suture showed deposits. She was treated by multiple topical and systemic antibiotics. Visual acuity improved to 0.9 two weeks later.

Conclusion: This case illustrates that endophthamitis may develop following microincision vitreous surgery. Suture of the scleral wound or fluid-air exchange may prevent infection after surgery.