眼内レンズ挿入術後眼内炎の起炎菌

Causative microorganisms in endopthalmitis following intraocular lens implantation

　1989〜2001年に名古屋大学医学部附属病院およびその関連病院で治療した眼内レンズ挿入術後眼内炎26眼を検討した。治療は眼内レンズ除去術，硝子体切除術を行い，前房水，眼内レンズ，水晶体嚢，硝子体を培養同定した。26眼中17眼（57％）に起炎菌（腸球菌4眼，表皮ブドウ球菌4眼，緑膿菌1眼，緑膿菌以外のブドウ糖非発酵グラム陰性桿菌6眼，アクネ菌2眼）が検出され，このうち緑膿菌以外のブドウ糖非発酵グラム陰性桿菌1眼，表皮ブドウ球菌2眼は多剤耐性菌であった。緑膿菌以外のブドウ糖非発酵グラム陰性桿菌の検出率が高く，この菌による眼内炎の予後は比較的よいものの，特に糖尿病患者や高齢者では起炎菌として考慮する必要があると思われた。

We reviewed 26 eyes of 26 patients with endophthalmitis following intraocular lens (IOL) implantation during the past 13 years. All the eyes were treated by IOL removal and topical antibiotics. Additional vitrectomy was performed in eyes with adnormal electroretinogram responses. Out of 26 specimens obtained during surgery, 17 eyes (57%) were culture-positive. Causative microorganisms comprised Enterococcus faecalis 4 eyes, Staphylococcus epidermidis 4 eyes, Propionibacterium acnes 2 eyes, Pseudomonas aeruginosa 1 eye, and glucose nonfermentative gram-negative rod (GNF-GNR) excepting Ps. aeruginosa 6 eyes. Staphylococcus epidermidis in 2 eyes and GNF-GNR in 1 eye were resistant to multiple antibiotics. The findings show a higher incidence of GNF-GNR than previously reported. While the outcome of eyes infected by GNF-GNR was fair, the possibility of GNF-GNR infection would merit due considereration in diabetic or aged patients with endophthalmitis following IOL implantation.