Fulminant endophthalmitis based on open globe injury by littereclaw: two case reports and literature overview | Journal of Ophthalmic inflammation and infection

Case 1

A 27-year-old woman presented herself to the emergency room after being scratched by a cat in the left eye. Last eyes were remarkable for high myopia and contact lens use. She had no relevant medical history in the past. During the examination, the visual acuity was 20/20 in the right eye and 20/400 in the left eye. The examination of the right eye was inconspicuous. The left eye was hypotonus and had an upper eyelid edema with a breakdown wound directly under the left eyebrow. She had a conjunctive and scleral injuries behind the nostril and subconjunctivals bleeding. The cornea was clear, but the anterior chamber was flat with a hyphaema, inflammatory fibriner strands and the total loss of the iris. The examination of the rear segment resulted in a glass bleeding, but an connected retina. Intravenous vancomycin and ceftazidiime were administered. An exploratory peritomy resulted in a 7 -mm ∼7 a.m. to 11 a.m. An overall aniridia was found (the loss of iris was a complete loss during the first trauma), with the remains of the Uveal pigment at the limits of the injury without further Uveal tissue prolapse. The injury was repaired and at the end of the procedure, intravitreal cefazi and vancomycin were administered. Postoperatively, she received topical prednisolone and moxifloxacin.

On day 1, the vision was a slight perception with projection. Intraocular pressure was 9 mmHg. The cornea was slightly edematous with 2 + descemet folds and a central endothelial plaque, which saves the peripheral 1–2 mm of the cornea. A front chamber fibrinous and hypopyon was found. B-scan ultrasound showed a connected retina and increased vitreous opacities with web-shaped echodensities (Fig. 1a).

In the patient, post-traumatic endophthalmitis was diagnosed and brought to the operating room on the same day to record a PARS-Plana vitrectomy, the collection of vitreous samples for bacterial and fungal cultures, detergent of the front chamber and intravitreale injection of vancomycin, cefazidim and preiconazole. She received oral amoxicillin clavulanic acid and topical prednisolone and moxifloxacin after the operation. Glass culture isolated Propionibacterium acnesBut SUSCECEPTIBILITY tests were not carried out.

One day after the second operation, visual acuity was a slight perception and the intraocular pressure was 3 mmHg in the left eye. The split lamp examination was remarkable for a 2 -mm hypopyone. The posterior investigation was limited due to the vitreous haze. The retina was attached to the B scan -ultrasound. On the postoperative day 8, the patient had a persistent inflammatory reaction of the front chamber and no view of the retina due to lentils and vitreous opaces. Increasing vitals and a connected retina were confirmed with B -Scan -Ultrasound. A pars -plana vitrectomy and a lensectomy were carried out, with inflammatory membranes and cryotherapy peeling to the peripheral retina behind the sclerotomies.

In the next few days, the visual acuity remained in the left eye with the light perception and the eye was hypotonic. The examination of the split lamps showed an edematous cornea and the resolution of the front chamber and the vitreous inflammation. The retina was appropriate.

A month after the second Pars Plana vitrectomy surgery, the visual acuity had improved with an intraocular pressure of 13 mmHg to count his fingers on one foot. An inferior retinal detachment from 4 a.m. to 7 a.m. with connected macula and no obvious proliferative vitreorentinopathy (PVR) was found. The optical coherence tomography (OCT) showed a distorted fovea and the external retinal tatrophy. She underwent a third Pars -Plana vitrectomy, whereby a placement of a #4050 buckle, endolaser and 25% SF6 gastam ponade surrounded. The retina remained as gas in the postoperative period. The best possible visual visual acuity improved one month after the last operation to 20/400 (Fig. 1b).

Seven months after the initial trauma, the patient was subjected to a secondary intraocular lens placement by intrasceral fixation (Yamane technology) and the implantation of an artificial iris in the left eye. Additional methods were carried out later, including glaucoma tube -Shunt -Shunt -Implantation and a desaek -stripping -endothel -Keratoplastics (DSAEK) for secondary glaucoma and corneal dyles.

A year after the initial trauma, the visual acuity was 20/200 in the left eye and the retina was attached. OCT showed a mild epiretinal membrane centrally and centrally and in terms of time and outer and diffuse atrophy (Fig. 1c).

Case 2

A 42-year-old man who was presented two days after the scratch in the right eye by his cat of the right eyelid swelling, pain and visual loss. During the presentation, the patient in the upper eyelid had a cut in full thickness and an alleged puncture in full thickness on the superotemporal limus. The pupil was irregular, but there was no tissue prolapse. The transferring eye care provider as no primary repair was required. He had no relevant medical or surgical history in the past.

During the examination, the visual acuity was a slight perception with projection in the right eye and 20/50 in the left eye. The left eye was inconspicuous and remained unchanged. The intraocular pressure was 29 mmHg in the right eye and 16 mmHg in the left eye. No afferent pupil supplies were determined by reverse announcement. There was a diffuse restriction of the extraocular motility of the right eye. The right upper and lower eyelids were red and swollen. The conjunctiva was strongly injected and chemotically with plenty of purulent discharges. The cornea had diffuse funeral and the front chamber had 3 + cells and a hypopyon. The iris was minimally reactive with irregular diffuse rear synechia and a fibrin membrane over the front lentil capsule. Due to dense vitritis, there was no view of the pool. B-scan ultrasound showed fibrinous membranes and debris in the vitreous cavity with a possible serous serious serious retinal detachment (Fig. 2a). There was a positive T-Sign that indicates a rear scleritis. In the patient, acute post-traumatic endophthalmitis was diagnosed and a 23-gauge-Pars-Plana vitrectomy with vitreous samples for microbiology cultures and intravitreales injection of ceftazidime, vancomycin and amphotericin B. during the operation. Glass culture identified Pasteurella Multocidasensitive to penicillin and ceftriaxone. The patient was started postoperatively with topical prednisolone and moxifloxacin.

Case 2 pictures. A: B scan ultrasound at the presentation. B: OptoS image according to the third pars Plana vitrectomy. C: Optical coherence tomography 6 months after the trauma

On the first day after the operational day, visual acuity was the slight perception in the right eye and the intraocular pressure was 12 mmHg. The right eye had corneal edema, severe inflammation of the front chamber and a limited view of the darkness in the retina. In addition, the presence of proponent, abnormal extraocular movement and CT scan finds brought the concerns about the right orbital cellulitis and panophthalmitis. The patient began with intravenous (IV) Vancomycin, Cefepime and Metronidazole, which were then switched to the recommendation of the infectious disease service to IV CEFTRIAXON and IV -Moxifloxacin.

In the next two weeks, the inflammation of the cornea and the front chamber and the extraocular movement improved. Intraocular pressure remained low. Due to vitreous hole, there was still no view of the retina. A B-scan ultrasound examination resulted in vitreous gangs that match contractile inflammatory membranes and a retinal detachment. A vitrectomy, lensectomy and 5,000 centiles (CS) silicone oil -tamponade operation were carried out. The retina was bound and the vision improved during the postoperative course. However, a recurring Rhegmatogenic retinal detachment with PVR formation was determined after two months. The patient underwent a repetition plana vitrectomy, a membrane shell and a retinectomy with silicone oil tamponade (Fig. 2b).

Six months after the initial trauma, the visual acuity counted its fingers on two feet, with the loss of peripheral seeing. The patient remained aphak. OCT showed no sub-fluid, no temporal atrophy, an epiretinal membrane and a possible dissolution of a small suburbetinal Perfluor-n-octane bladder more intensely (Fig. 2c). Plans for the scleral fixation of an intraocular lens were discussed; In view of a poor visual forecast, however, the decision was made to observe.