Endophthalmitis due to 5 eyelashes, whichentered 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 ofthe 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 chamberand 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. 2nd January. An injury by a metal occured. On the same day, the first medical examination was done.On the same day, the first medical examination was done.The findings showed iris prolapse and vitreous bleeding.The findings showed iris prolapse and vitreous bleeding.The Retina couldn’t be seen.The Retina couldn’t be seen.

A metalic foreign body couldn’t be found by CT A metalic foreign body couldn’t be found by CT and XP check.and XP check.

3rd January, 23rd January, 2~3am. Sclera suture was performed.3am. Sclera suture was performed.

6th January, ( 3days after 6th January, ( 3days after operation).operation).Inflammation became worse.Inflammation became worse.So Vancomycin 1mg and So Vancomycin 1mg and Ceftazidime Hydrate 2mg, Ceftazidime Hydrate 2mg, Vitreous injectionVitreous injection 　　 were were administered.administered.

5th January, (2days after 5th January, (2days after operation)operation)Vitreous inflammationVitreous inflammationincreased particulary in increased particulary in the periphery.the periphery.

7th January, (4 days after operation).7th January, (4 days after operation).Vitreous inflammation and bleeding increased more.Vitreous inflammation and bleeding increased more.So Vitrectomy was done, and a vitreous foreign bodiesSo Vitrectomy was done, and a vitreous foreign bodies(5 eyelashes) were removed.(5 eyelashes) were removed.

Eyelashes

Pals planaPals plana

Eyelashes were removed from pals plana.Eyelashes were removed from pals plana.

Eyelashes removed in the vitreous.Eyelashes removed in the vitreous.

・・ 8th Jan.2009: (1day after Removal of foreign bodie8th Jan.2009: (1day after Removal of foreign bodies s and Vitrectomy)and Vitrectomy) 　　 Anterior Chamber Vitreous Anterior Chamber Vitreous 　　 opacityopacity 　　 improved. Intra vitreous injection of improved. Intra vitreous injection of Isepamicin, Cefozopran hydrochloride.Isepamicin, Cefozopran hydrochloride.

5 extracted eyelashes5 extracted eyelashes

Eyelashes : Eyelashes : Keratin is the main ingredient.Keratin is the main ingredient. Keratin is a protein. Bacteria and Keratin is a protein. Bacteria and filamentous bacteria ofen exist.filamentous bacteria ofen exist.

Fluid cultures of the anterior chamber and vitreous were Fluid cultures of the anterior chamber and vitreous were bacteria-negative. The PCR method could not identify bacterial species.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 eyeEyelashes in vitreous of perforated eye 　　 injury. injury. (3cases were repoted in the past)(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)

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.

Are they able to detect intravitreal eyelashes?

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.