硝子体手術と術後の抗菌薬硝子体内注射が奏効したクレブシエラ肺炎桿菌による眼内炎

A case of Klebsiella pneumoniae endophthalmitis treated by vitreous surgery and intravitreal injection of antibiotics

要約　目的：硝子体切除術および術後の抗菌薬硝子体内注射が奏効した内因性眼内炎の1例を経験したので報告する。

症例：肝膿瘍疑いのある69歳の男性で，左眼視力低下の主訴で当科を紹介受診した。左眼矯正視力は0.2であり，硝子体混濁および網膜下膿瘍を認め，肝膿瘍由来の内因性眼内炎が疑われた。翌日，眼内炎の増悪を認め，硝子体切除術を施行した。網膜下膿瘍の穿刺と排膿は行わず，水置換で手術を終了した。血液培養でKlebsiella pneumoniaeが検出され，術翌日より4日間セフタジジムの硝子体内注射を行った。6か月後には左眼矯正視力は1.2に改善した。

結論：眼内炎発症後早期に硝子体手術を施行し，術後に抗菌薬硝子体内注射を行ったことで，良好な治療後視力を得ることができた。

Abstract　Purpose: To report a case of metastatic Klebsiella pneumoniae endophthalmitis with favorable outcome following vitreous surgery and intravitreal injection of antibiotics.

Case: A 69-year-old male was referred to us for impaired vision in the left eye. He had had fever since one week before and been suspected of liver abscess.

Findings and Clinical Course: Corrected visual acuity was 1.0 in the right eye and 0.2 in the left. The left eye showed signs of inflammation in the anterior chamber and the vitreous. The left fundus showed multiple hemorrhagic patches. Subretinal abscess was present in the temporal sector. The findings were suggestive of endogenous endophthalmitis secondary to liver abscess. The left eye showed hypopyon the next day and was treated by vitrectomy. Culture of circulating blood showed Klebsiella pneumoniae. The left eye received intravitreal injection of ceftazidime for 4 consecutive days. Signs of inflammation subsided and the left visual acuity improved to 1.2 six months later.

Conclusion: This case illustrates that early vitrectomy and intravitreal injection of antibiotics may be effective for endogenous endophthalmitis without recourse to drainage of subretinal abscess.