Retinal Vasculitis Following Corneal Penetrating Injury-A Case Report

角膜穿刺傷後引起視網膜血管炎－病例報告

林佩璇(Pei-Hsuan Lin) ； 王南凱(Nan-Kai Wang) ； 陳冠任(Kuan-Jen Chen) ； 林耕國(Keng-Kuo Lin) ； 葉龍坤(Lung-Kun, Yeh)

《中華民國眼科醫學會雜誌》 48卷4期 (2009/12) Pp. 540-543

https://doi.org/10.30048/ACTASOS.200912.0033

摘要

目的：報告一例小孩角膜穿刺傷後造成視網膜血管炎的病例報告。
方法：病例報告。
結果：一個九歲健康的男孩，左眼角膜遭圓規刺穿後，角膜穿刺破裂且有房水持續流出但前房並未塌陷，也沒有外傷性白內障或玻璃體膨出。斷層掃瞄顯示並無眼內異物。經角膜修補後旋即出現前房積膿的現象，懷疑為感染性眼內炎。除了抽取前房液做細菌培養外，並以均溶液及抗生素沖洗，並開始使用局部抗生素治療。但前房積膿只有輕微改善，細菌培養結果並未培養出細菌生成。眼底檢查出現血管邊緣模糊，眼底螢光檢查發現血管滲漏。因此診斷為血管炎，並開始使用類固醇治療一週後，前房積膿消失，且眼底恢復正常。追蹤六個月，視力恢復正常並無其他併發症。
結論：外傷性眼內炎在小孩很少見，但卻可能因外傷造成感染性或非感染性之眼內炎引起之發炎反應導致發炎性血管炎。因此鑑別診斷二者之差異及早期給予適合之治療，對視力之恢復是很重要的。

並列摘要

Purpose: To report a case of retinal vasculitis after a cornea penetrating injury.
Methods: Case report.
Result: A 9-year-old boy who denied any systemic disease and ocular disorder except myopia (OU: -2.0D) was brought to our emergency department due to left eye stabbing injury by a dividers. Visual acuity was 20/200 (OU). Ocular examination showed corneal perforation with a positive Seidel test. There was no traumatic cataract and anterior chamber was formed. An orbital CT scan revealed no intraocular foreign body and normal eyeball contour. Unfortunately, the phenomenon of increased inflammatory reaction in the anterior chamber was noted and hypopyon developed within 18 hours after the primary repair surgery. Although the B-scan result showed no obvious media opacity in the vitreous cavity, fundus examination revealed peripheral vitreous opacity and sheathing retinal vessels. Fundus fluorescein angiography showed fluorescein leakage along the vessels. The anterior chamber aqueous was tapped for culture and irrigated with sterile balanced salt solution. Antibiotics were given by intracameral injection under suspicion of infection. The culture results disclosed negative findings. Hypopyon was resolved and the anterior chamber reaction subsided within two weeks. His best corrected vision was 20/20 (OS) after a 6 months follow-up.
Conclusion: Retinal vasculitis in children which occurs following corneal penetrating injury is very rare. The prognosis can be quite good with appropriate management.

並列關鍵字

Endophthalmitis ； hypopyon ； vasculitis