放射根瘤菌致白内障术后急性眼内炎首例报告

Report on the first case of acute endophthalmitis caused by Rhizobium radiobacter after cataract surgery

了解放射根瘤菌致白内障术后急性眼内炎的临床特点及治疗转归。回顾性收集1例白内障患者手术后放射根瘤菌急性眼内炎的临床资料,结合国内外相关文献进行分析。患者右眼白内障手术后4 d,出院后因“右眼急性化脓性眼内炎”收住入院。入院当天即行右眼玻璃体切割联合人工晶体取出、后囊膜切开等手术,术中取玻璃体液培养,结果为放射根瘤菌,可能是接触蔬菜根上的土壤后触摸眼结膜引发感染。采用敏感抗菌药物头孢他啶(全身用药)和左氧氟沙星(局部滴眼)治疗,术后21 d眼部症状稳定,矫正视力为20/133,眼部感染治愈出院。此病例为国内首例白内障手术后放射根瘤菌急性眼内炎,临床应重视由该菌引起的眼部感染,白内障手术后或玻璃体内注射药物后应避免接触土壤,出现症状需及时送细菌培养,并根据药敏结果进行精准治疗。

To understand the clinical characteristics and treatment outcome of acute endophthalmitis caused by Rhizobium radiobacter(R.radiobacter)after cataract surgery.Clinical data of a patient with acute endophthalmitis caused by R.radiobacter after cataract surgery were collected retrospectively.Combined with relevant domestic and foreign literatures,analysis of the data was conducted.Four days after cataract surgery,the patient was admitted to the hospital again due to“acute suppurative endophthalmitis in the right eye”.On the day of admission,vitrectomy combined with intraocular lens removal and posterior capsulotomy was performed in the right eye.Vitreous fluid was collected during the operation and cultured.R.radiobacter was identified.The infection might come from the contact with the conjunctiva after touching soil on vegetable roots.Sensitive antimicrobial agents of ceftazidime(systemic medication)and levofloxacin(local eye drops)were used for treatment.Symptoms of the eye remained stable 21 days after surgery,with a corrected vision of 20/133.Eye infection was cured,and the patient was discharged from the hospital.This is the first case of acute endophthalmitis caused by R.radiobacter after cataract surgery in China.Clinical attention should be paid to eye infection caused by this pathogen.After cataract surgery or intravitreal injection of drugs,contact with soil should be avoided.Pathogenic culture should be performed in time once symptoms occur,and precise treatment should be given based on antimicrobial susceptibility test results.