強膜内陥術時の排液部からの感染が疑われた眼内炎の1例

A case of endophthalmitis from the drainage sclerotomy of scleral buckling

要約　目的：強膜内陥術後に眼内炎をきたした報告は少ない。今回，強膜内陥術時の排液部からの感染が疑われた眼内炎の1例を経験したので報告する。

症例：49歳，男性。手術日X日の1〜2週間前から右眼の飛蚊症を自覚した。X−3日から右眼の耳下側に影が見えるとの訴えで前医を受診した。右眼網膜剝離を認めたために，精査加療目的に当院を紹介され受診となった。X日に強膜内陥術を施行した。X＋3日目に眼痛が増強し，前眼部炎症が著明になり，毛様充血，結膜浮腫，眼瞼腫脹を認めたため，眼底透見は困難であった。術後眼内炎と診断し，同日硝子体手術を施行した。セフタジジム20mgとバンコマイシン塩酸塩10mgを500mlの灌流液に混注した。排液部に一致した網膜下に黄色滲出斑と膿瘍を認めたことから，排液部から感染したと考えた。バックルを摘出せずに，膿瘍部の網膜を切開して排膿を行った。セフタジジム20mg/mlとバンコマイシン塩酸塩10mg/mlを結膜下注射して終了した。後日，前房水と硝子体液の培養では陰性が報告されたが，急速に進行した経過から細菌性眼内炎が疑われた。X＋13日に網膜剝離が再発した。X＋14日に硝子体手術とシリコーンオイル注入術を施行した。X＋4か月後にシリコーンオイル抜去術と眼内レンズ挿入術を施行した。X＋7か月後，網膜剝離の再発はない。

結論：強膜内陥術時の排液部からの細菌性感染が疑われた術後眼内炎に対し，網膜を切開して排膿することで良好な視力を得られた症例を経験した。

Abstract　Purpose：Endophthalmitis after scleral buckling has been reported previously. This time, we report a case of endophthalmitis suspected of infection from the drainage section during scleral buckling.

Case：The patient was a 49-year-old man. He realized floater of the right eye from 1 to 2 weeks ago. He went to the hospital saying that a shadow was visible on the under-ear side of his right eye from 3 days ago. He was diagnosed with retinal detachment and transferred to our department for surgical treatment. Scleral buckling was performed on day X. On day X＋3, eye pain was enhanced, and anterior inflammation became worse. Ciliary injection and conjunctival edema were recognized, and it was difficult to see through the fundus. He was diagnosed with endophthalmitis and performed vitreous surgery on the same day. Ceftazidime 20 mg and vancomycin 10 mg hydrochloride were mixed into 500 ml perfusion solution. Yellow exudation plaques and abscesses were observed under the retina with the drainage part during the operation. We diagnosed this case was infected from the drainage part. Ceftazidime 20 mg/ml and vancomycin 10 mg/ml were injected into subconjunctival. Later, the culture of anterior aqueous humor and vitreous fluid was reported negative. On day X＋13, retinal detachment recurred. On day X＋14, vitreous surgery and silicone oil injection were performed. Four months from day X, silicone oil removal and intraocular lens implantation were performed. Seven months from day X, retinal detachment did not recur.

Conclusion：We experienced endophthalmitis suspected of infection from the drainage section during scleral buckling, in which good visual acuity was obtained by incising the retina and draining intraocular inflammation.