早期硝子体手術が奏効した肝膿瘍原発の転移性細菌性眼内炎の1例

Early vitreous surgery was effective in a case of bacterial endophthalmitis metastatic from liver abscess

要約　目的：早期の硝子体手術が奏効した肝膿瘍原発の転移性細菌性眼内炎の1例の報告。症例：65歳女性に発熱と意識障害などが突発し，肝膿瘍と診断された。抗菌薬による治療開始から4日後に右眼に眼痛と視力低下が生じた。矯正視力は右指数弁，左0.5で，右眼に前房蓄膿，硝子体混濁，網膜出血があり，内因性眼内炎と診断した。経過：即日眼科に入院のうえ，水晶体と硝子体を全切除した。耳側赤道部より周辺には網膜壊死があった。術中に採取した硝子体液からKlebsiella pneumoniaeが検出された。手術後，眼内炎は鎮静化し，9か月後の右眼矯正視力は0.7に改善した。結論：本症例は肝膿瘍の転移による眼内炎と解釈される。このような内因性細菌性眼内炎と診断した場合には，徹底的な眼内郭清を行うことで良好な予後を得ることがある。

Abstract.　Purpose：To report a case of bacterial metastatic endophthalmitis from liver abscess that was effectively treated by early vitreous surgery. Case：A 65-year-old woman developed acute fever and mental disturbance. She was diagnosed with liver abscess and was treated with systemic antibiotics. On day 4 of treatment, she noted pain and blurring in her right eye. Her corrected visual acuity was counting fingers right and 0.5 left. Her right eye showed hypopyon, vitreous opacity and retinal hemorrhages, leading to the diagnosis of endogenous endophthalmitis. Clinical Course：She underwent total vitrectomy and lensectomy the same day. As intraopetative finding, the right eye showed retinal necrosis peripheral to the equator in the temporal sector. Klebsiella pneumoniae was isolated from vitreous specimen. Endophthalmitis subsided after surgery, resulting in visual acuity of 0.7 nine months later. Conclusion：Endophthalmitis in the present case was interpreted as metastatic from liver abscess. This case illustrates that prompt vitreous surgery may be effective for bacterial metastatic endophthalmitis.