J Korean Ophthalmol Soc.  2011 Jan;52(1):97-102. 10.3341/jkos.2011.52.1.97.

A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation

• Lee SY
• Heo JW
• Wee WR
• Lee JH
• Kim MK

• KMID: 2214144
• DOI: http://doi.org/10.3341/jkos.2011.52.1.97

Abstract

PURPOSE
To report a case of a patient with infectious endophthalmitis associated with necrotizing scleritis that was treated with pars plana vitrectomy and permanent amniotic membrane transplantation.
CASE SUMMARY
A 76-year-old man with pain and visual loss in the right eye was diagnosed with infectious endophthalmitis and necrotizing scleritis. The visual acuity in the right eye was hand motion, and the slit lamp examination showed infection of the conjunctiva and sclera, corneal edema, hypopyon, and necrosis of nasal sclera. An intravitreal antibiotic injection was given, and Pseudomonas aeruginosa was cultured in vitreous fluid. Two days afterward, when vitrectomy was performed, leakage from the scleral microperforation and necrosis of the peripheral cornea was observed. Thus, a 10-layered permanent amniotic membrane transplantation was performed. The patient was given topical antibiotics and steroids, oral prednisolone, and cyclophosphamide postoperatively. After 74 days, endophthalmitis was remitted, and scleritis was well controlled. His visual acuity recovered to 20/40.
CONCLUSIONS
Infectious endophthalmitis due to scleral microperforation by necrotizing scleritis can be treated effectively with vitrectomy combined with permanent amniotic membrane transplantation.

Keyword

Amniotic membrane; Endophthalmitis; Scleritis

MeSH Terms

Aged
Amnion
Anti-Bacterial Agents
Conjunctiva
Cornea
Corneal Edema
Cyclophosphamide
Endophthalmitis
Eye
Hand
Humans
Necrosis
Prednisolone
Pseudomonas aeruginosa
Sclera
Scleritis
Steroids
Transplants
Visual Acuity
Vitrectomy
Anti-Bacterial Agents
Cyclophosphamide
Prednisolone
Steroids

Figure

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  Figure 1. (A), (B), (C) The right eye at the first visit presented conjunctival injection, corneal edema, hypopyon, scleral edema, necrosis and thinning in nasal sclera, and epithelial defect in the nasal peripheral cornea. (D), (E) Ultrasonogram (B-scan) shows haziness in the vitreous and posterior sclera thickening at the first visit. (F), (G), (H) Amniotic membrane is intact in the necrotic nasal sclera 2 days after permanent amniotic membrane transplantation. White temporary amniotic membrane covered entire cornea and nasal conjunctiva. (I), (J), (K) At 74 days after treatment, conjunctival and scleral injection was nearly disappeared, and there is no epithelial defect in cornea and conjunctiva. (L), (M) Ultrasonogram (B-scan) shows a clear vitreous cavity and no posterior sclera thickening.

Reference

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