診断・治療に苦慮した術後遅発性眼内炎の1例

A case of late-onset postoperative endophthalmitis with diagnostic and therapeutic difficulties

要約　目的：白内障手術の半年後に出現し，薬剤抵抗性にて遷延化，観血的治療で軽快した術後遅発性眼内炎の報告。症例：80歳，女性。左眼白内障手術の半年後から左眼前房炎症が出現し，近医総合病院を受診した。前房内線維素析出と前房蓄膿，眼内レンズ前後面に白色塊が認められた。抗生物質，ステロイドで一旦軽快したが，減量にて再燃した。再燃時，眼内レンズ上に綿花様白色塊が出現し拡大した。真菌感染が疑われたものの保存的加療では効果不十分であったため，当院を受診した。二度の手術を受け，眼内レンズ・水晶体囊摘出，硝子体切除，抗真菌薬の眼内灌流を施行された。術後は再燃なく，視力良好である。結論：病理で真菌が確認され，真菌性眼内炎と推定された。水晶体囊・眼内レンズ摘出，抗真菌薬の眼内灌流が有効であった。

Abstract.　Purpose：To report a case of late-onset endophthalmitis 6 months after cataract surgery. Case：80-year-old female underwent left cataract surgery. 6 month later,her left eye showed inflammation in anterior chamber. She was referred to a general hospital. A white mass was presented under the intraocular lens with fibrin and hypopyon. The inflammation was improved by antibiotics and corticosteroids,but worsened when the dose of corticosteroid was reduced. White fluffy exdates was appeared and spread on the intraocular lens. Antifungal agents were not enough to treat effectively. Removal of the intraocular lens,the lens capsule,vitrectomy and irrigation with antifungal drugs were taken in our hospital. After two surgeries,her visual acuity is 20/20. Conclusion：Fungal organism was fined pathologically,suggesting that this case was fungal endophthalmitis. Removal of the intraocular lens,the lens capsule,and irrigation with antifungal drugs were effective.