Transcript Eyelashes
Endophthalmitis due to 5 eyelashes, which entered the vitreous during occurrence of perforated eye injury Yoshihide Nakai, Kyoko bessho, Yuko Shono, Yoshimasa Nakai (Tokai eye Clinic, Tsu, Japan) Finacial Interest is None. Purpose: Endophthalmitis occured 2days after scleral suturing of the perforated eye, so vitrectomy was done, and 5 eyelashes were found. After extraction of these eyelashes, endophthalmitis improved. In this presentation, we report a case which is very rare. Methods: A 29-year-old man had iris prolapsed and scleral perforation because of a wire which hit his left eye. CT scanning, X-ray, B-mode, etc. revealed no foreign body in the eye. On the day of the examination, iridectomy and scleral suturing were performed, and antibiotics were administered. On the following day, number of cells of the anterior chamber and vitreous body were increased. Therefore, vancomycin hydrochloride 1mg and ceftazide hydrate 2mg were injected into the vitreous body. After that, the opacity of the vitreous became further exacerbated, which led to phacoemulsification and vitrectomy 4 days after the injury. 2nd January. An injury by a metal occured. On the same day, the first medical examination was done. The findings showed iris prolapse and vitreous bleeding. The Retina couldn’t be seen. A metalic foreign body couldn’t be found by CT and XP check. 3rd January, 2~3am. Sclera suture was performed. 5th January, (2days after operation) Vitreous inflammation increased particulary in the periphery. 6th January, ( 3days after operation). Inflammation became worse. So Vancomycin 1mg and Ceftazidime Hydrate 2mg, Vitreous injection were administered. 7th January, (4 days after operation). Vitreous inflammation and bleeding increased more. So Vitrectomy was done, and a vitreous foreign bodies (5 eyelashes) were removed. Eyelashes were removed from pals plana. Pals plana Eyelashes Eyelashes removed in the vitreous. ・8th Jan.2009: (1day after Removal of foreign bodies and Vitrectomy) Anterior Chamber Vitreous opacity improved. Intra vitreous injection of Isepamicin, Cefozopran hydrochloride. 5 extracted eyelashes Eyelashes : Keratin is the main ingredient. Keratin is a protein. Bacteria and filamentous bacteria ofen exist. Fluid cultures of the anterior chamber and vitreous were bacteria-negative. The PCR method could not identify bacterial species. ・9~14th Jan. Anterior Chamber Vitreous Opacity improved more. ・15th Jan: L-Visual acuity: 0.01(0.3+12D) ・1st sep: L-visual acuity 1.0(1.2+0.5D=cyl-1.0D180) Eyelashes in vitreous of perforated eye injury. (3cases were repoted in the past) 1)Seawright AA etc：Intravitreal cilia in phakic penetrating eye injury Australian and New Zealand Journa of pthalmology. 25:133-135,2007 (2 cases) 2)Asako Kawaguchi, Yoshitsugu Inoue Eyelashes in the posterior eye segment in a case of penetrating eye injury. 58:109-111,2004 (1 case) Are they able to detect intravitreal eyelashes? It’s impossible to detect eyelashes by XP, CT, MRI. B-mode: Kawaguchi couldn’t detect eyelashes. Sea wright: It’s possible to detect eyelashes in a turn, size and the location of the injury? UBM: The degree of organization and reaching is bad. Anterior segment OCT: It isn’t generally available. Results: During vitrectomy, 5 eyelashes were detected in the ciliary pars plana near the scleral perforation. After the eyelashes were removed, the vitreous body was washed with antibiotics. Fluid cultures of the anterior chamber and vitreous body were bacteria-negative. In addition, the PCR method could not identify bacterial species. After the operation, the opacities of the anterior chamber and vitreous body were improved, and the visual acuity became 20/400(20/20×+12D) 3 months after vitrectomy. Conclusion: Eyelashes are difficult to detect by usual examinations. Therefore, even if CT scanning, etc. reveal no foreign bodies in perforated eyes, it is necessary to conduct postoperative management. Patients showing deterioration of the opacity of the vitreous by injection of antibiotics into the vitreous need to undergo vitrectomy immediately.