-
8/12/2019 Intricate Treatment of Endophtalmitis
1/6
Intricate treatment of Endophtalmitis - case
reportAuthors:
Dr. Ionela IosubCoordinator: Dr. Livia Sram
Emergency Eye Hospital, Bucharest
Case report
Personal data: V. E. A., 9 years, girl, hospitalized in
Emergency Eye Hospital 26.05.2012,
presentation is with blurred vision, photophobia RE for 5 days,
without a history of ocular
trauma, 25.05.2012 Valcea Hospital: Uveitis with hipopion;
General examination: normal ponderal status, AT=100/65 mmHg
AF=90 hbm,
External examination: RE vision=hand movement RE tension=12 mmHg
LE vision=1 LE
tension=16mmHg, RE: normal ductions and versions, RE=cellular
deposits on the corneal
endothelium, hypopyon, fibrinous exudate;
Fundus examination: inexplorable; LE: normal external and fundus
examination;
Special investigation: WBC 13,5 (3,9-9,6/1000/uL); NEUTROPHILS
84,3 (37,0-73,0/%);
LYMPHOCYTES 11,8 (20-55/%); FIBRINOGEN 457 (180-350 mg/dL); VSH
60 (5-15); TOXOCARA CANIS
3,901 NTU (
-
8/12/2019 Intricate Treatment of Endophtalmitis
2/6
CT - To exclude sarcoidosis, multiple sclerosis and primary
intraocular lyphoma
Chest X-ray - To exclude tuberculosis and sarcoidosis
-
8/12/2019 Intricate Treatment of Endophtalmitis
3/6
Diagnosis
Principal Diagnostic: RE Endophtalmitis
Anterior uveitis: keratic precipitates, hypopyon, fibrinous
exudate Posterior uveitis: vitreous haze, choroidal oedema.
Differential diagnosis
Primary intraocular lymphoma Fuchs uveitis syndrome A peripheral
toxocara granuloma Amyloidosis
Etiological:
Idiopathic or sistemic associations: Parasitic: toxoplasmosis,
toxocariasis Bacterial: TB, syphilis, Lyme disease, brucellosis,
endogenous bacterial endophtalmitis, cat-
scratch disease
Viral: citomegalovirus retinitis, HIV microangiopathy Fungal:
Neurological: multiple sclerosis , Vogt-Koyaagi-Harada syndrome,
Behcet syndrome, Rheumatic: spondyloarthropathies, juvenile
arthritis Gastro-intestinal: Crohn disease, Whipple disease
Sarcoidosis
Treatment
26.05.2012-10.06.2012Sistemic treatment:
1. Tienam 500 mg i.v. 12 h2. PDN 30 mg/day- (after 7 days 25
mg)3. Diflucan 1 cp/day
-
8/12/2019 Intricate Treatment of Endophtalmitis
4/6
4. Dicarbocalm 1 tbx3/dayLocal treatment RE: Nettildex, Edicine,
Axetine, Diflucan, Tropicamid, Fenefrin (1 dx6/day).
07.06.2012RE intravitreal triamcinolone injection.
Discarge: RE vision=hand movements, RE tension=13 mmHg
Course
2.07.2012RE vision=1/24 RE tension=11 mmHg 9.07.2012 RE
vision=0,1 (PDN=12,5 mg) 23.07.2012RE vision=0,2 pinhole
30.07.2012RE vision=counter finger at 20 cm
Complication: cataract
Surgical treatment
31.07.2012RE : vitrectomy, EEC , IOL-CP in sulcus.
Discharge01.08.2012RE vision=1/6 1/4 pinhole 03.09.2012RE
vision=0,8 0,9 with glasses (+0,5sfd -0,75cyld /180 degrees)
-
8/12/2019 Intricate Treatment of Endophtalmitis
5/6
-
8/12/2019 Intricate Treatment of Endophtalmitis
6/6
