PDF(Pubmed)
Abstract：
Objective: This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. Methods: A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. Results: The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Discussion: Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. Conclusion: The case\'s uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. Abbreviations: TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.
摘要：
目的：本病例报告旨在描述注射后眼内炎的异常临床表现和组织病理学特征。方法：一名56岁的男性糖尿病性视网膜病变患者接受了玻璃体内注射（根据患者的贝伐单抗），用于其他地方的新生血管性青光眼，并在给药hypopyon后一天被送往我们的中心。眼睛相对较白，没有疼痛或眼睑水肿。患者被治疗为注射后眼内炎的病例，间隔48小时服用两剂玻璃体内抗生素。在后续行动中,他患上了Covid感染.一周后,当媒体清除时，在视网膜相对健康的玻璃体腔中观察到白色渗出物。他接受了平坦部玻璃体切除术和玻璃体活检以进行组织病理学研究。结果：玻璃体抽吸物的显微镜检查显示结晶沉积物，没有任何微生物。两张控制幻灯片,一种是玻璃体内抗生素的混合物，以前注射过，另一个用新鲜的曲安奈德也进行了检查。尽管药物混合物的发现与玻璃体抽吸物不匹配，他们配用曲安奈德，将其确定为由于在其他地方注射曲安奈德而引起的假性眼内炎。讨论：最初，这似乎是一个简单的注射后眼内炎病例，但对玻璃体抽吸物的进一步检查显示，这是玻璃体内注射曲安奈德所致的假性眼内炎。尽管病人是有病的，新生血管形成或眼内压升高可能导致血眼屏障的破坏和曲安奈德向前房的迁移。结论：该病例的独特性在于是第一例有晶状体虹膜隔膜完整的有晶状体患者的假性眼内炎病例。此案还强调了对可用资源的明智利用和开箱即用的想法，以得出可能并不总是显而易见的诊断。缩写：TA=曲安奈德，AC=前房,IVB=玻璃体内注射贝伐单抗，PL=光的感知。
