アーメド緑内障バルブインプラント後にMRSA感染をきたした血管新生緑内障の1例

MRSA infection following Ahmed glaucoma valve implantation in a case of neovascular glaucoma

要約　目的：アーメド緑内障バルブ（AGV）を用いたチューブシャント手術後にメチシリン耐性黄色ブドウ球菌（MRSA）感染をきたした症例報告。

症例：66歳，男性。放射線網膜症から右眼血管新生緑内障（NVG）を発症，AGVによるチューブシャント手術を施行した。術後9日目に眼痛，眼脂，前房炎症の増加を認め，眼脂培養からMRSAを検出した。保存的加療は著効せず，術後30日目にAGV抜去を施行。炎症は軽快した。

結論：チューブシャント手術では人工物（GDD）の眼内留置を行うため，放射線治療の既往症例では創傷治癒不良からGDDへの術後感染をきたす可能性があり注意が必要である。

Abstract　Purpose：To report a case of neovascular glaucoma who developed methicillin-resistant Staphylococcus aureus（MRSA）infection following Ahmed glaucoma valve implantation.

Case：A 66-year-old male developed neovascular glaucoma in the right eye. He had diabetes mellitus. He had received surgery and radiation for right maxillary carcinoma 2 years before.

Findings and Clinical Course：Corrected visual acuity was 0.06 in the right eye and 0.8 in the left. The right eye showed rubeosis iridis and extensive peripheral anterior synechia. He was treated by Ahmed glaucoma valve implantation. He showed ocular pain, profuse discharge, and signs of anterior chamber inflammation 9 days after surgery. Culture of the aqueous showed MRSA. The intraocular inflammation failed to respond to conservative medical treatment. It finally resolved after removal of Ahmed glaucoma valve on day 30 after surgery.

Conclusion：This case illustrates that postoperative infection may develop following implantation of glaucoma drainage device in a high-risk eye including diabetes and radiation treatment.