内因性細菌性眼内炎に対し硝子体手術を施行した4例

Four cases of vitrectomy for endogenous bacterial endophthalmitis

要約　目的：内因性細菌性眼内炎に対し硝子体手術を施行した4症例を報告する。

症例：症例1は83歳，女性。左眼内炎で初診時左眼視力は10cm指数弁であった。同日より抗菌薬の点滴静注を施行し，第3病日に硝子体内注射を，第11病日に硝子体手術を施行した。左眼視力は最終的に（0.5）を得た。血液培養からAggregatibacter actinomycetemcomitansが検出された。

　症例2は51歳，男性。両眼眼内炎で初診時矯正視力は右0.02，左10cm指数弁であった。同日抗菌薬の両眼硝子体注射と点滴静注を，第4病日に右眼硝子体手術を施行したが両眼失明に至った。肝膿瘍ドレナージにてKlebsiella pneumoniaeが検出された。

　症例3は46歳，女性。右眼内炎で初診時右眼矯正視力は0.01であった。同日より抗菌薬の点滴静注を開始した。第53病日に硝子体手術を施行し，右眼手術から3か月で右眼視力は0.3まで改善した。尿路感染，左腸腰筋膿瘍が疑われ，血液培養からStreptococcus agalactiaeが検出された。

　症例4は73歳，女性。肺炎と意識障害で入院し，各種培養からK. pneumoniaeが検出され，抗菌薬の全身投与が行われていた。意識回復後に左眼痛を訴え当科を受診し左眼視力は光覚弁であった。硝子体手術施行したが，失明に至った。

結論：内因性細菌性眼内炎は抗菌薬の全身投与が第一であり，早急な治療開始を要する。経時的な悪化や網膜剝離などの合併が疑われた際には手術に踏み切り，手術困難な場合は硝子体注射の頻回投与を考慮すべきである。

Abstract　Purpose：To report four cases of vitrectomy for endogenous bacterial endophthalmitis.

Case：Case 1 was an 83-year-old woman. Her left eye corrected visual acuity was a 10 cm count finger at the first visit due to endophthalmitis. She underwent intravenous and intravitreal injection of antibacterial agents on the same day and vitrectomy on the 11th day after the first visit. Her corrected visual acuity was 0.5. Aggregatibacter actinomycetemcomitans was detected in a blood culture.

　Case 2 was a 51-year-old man with binocular endophthalmitis and a corrected visual acuity of 0.02 on the right and handmotion on the left at the first visit. Binocular vitreous injections and an intravenous drip infusion of antibacterial agents were performed immediately, and vitreous surgery was performed on her right eye 4 days later, but binocular blindness occurred. Klebsiella pneumoniae was detected in liver abscess drainage.

　Case 3 was a 46-year-old woman. Her corrected visual acuity of the right eye was 0.01 at the first visit for right endophthalmitis. She was started on intravenous infusion of antibacterial drugs on the same day. She underwent vitrectomy on the 53rd day of the illness, and her right eye vision improved to 0.3, 6 months after the start of treatment. A urinary tract infection and left iliacus abscess were suspected, and Streptococcus agalactiae was detected in the blood culture.

　Case 4 was a 73-year-old woman. She was hospitalized for pneumonia and impaired consciousness, K. pneumoniae was detected in various cultures, and she was administered systemic antibiotics. After she regained consciousness, she complained of left eye pain and she visited our department and her left eye vision was a light perception. Despite a vitrectomy, she suffered blindness in her left eye.

Conclusion：For endogenous bacterial endophthalmitis, systemic administration of antibacterial agents is the first priority, and treatment should be started immediately. Surgery should be undertaken when complications such as deterioration over time or retinal detachment are suspected, and frequent administration of vitreous injections should be considered when surgery is difficult.