白内障術後のMRSA眼内炎の臨床経過—治癒例と非治癒例の比較

Endophthalmitis due to methicillin:resistant Staphylococcus aureus ( MRSA) after cataract surgery

　白内障術後の眼内炎11例のうちMRSA眼内炎3例の臨床像，治療について検討し，非治癒例の理由を検討した。MRSA眼内炎の発症は感染性眼疾患，無縫合眼に関係があり，眼内レンズ挿入眼に術．後平均4.3日と早期に発症していた。眼痛がないことを除いては眼所見に特徴的なものはなかった。MRSA眼内炎の治癒例と非治癒例では，眼内炎発症が非治癒例のほうが比較的早く，保存的治療のみだったのに対し，治癒例は早期に硝子体手術＋眼内レンズ摘出術が行われた。MRSA眼内炎を眼所見のみで診断することは困難であるが，臨床経過で推測でき，また早期の硝子体手術＋眼内レンズ摘出術は，治療および診断に必要であると思われた。

We reviewed eleven cases of endophthalmitis following cataract surgery. The series included three cases due to infection by methicillin-resistant Staphylococcus aureus (MRSA). These cases had external eye infection and sutureless surgery as risk factors. The endophthalmitis developed after an average of 4.3 days following intraocular lens (IOL) implantation.The MRSA-induced cases were similar in clinical manifestations as the other 8 cases except the absence of ocular pain.Two of the three MRSA-induced eyes resulted in clinical cure after additional vitreous surgery and IOL removal.The other eye, in which endophthalmitis developed earlier than the rest and which was treated by conservative means only, had to be eventually enucleated. The findings show that MRSA-induced endophthalmitis manifests nonspecific clinical features and that early vitrectomy and IOL removal facilitate cure and etiological diagnosis.