A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation

Sang Yoon Lee; Jang Won Heo; Won Ryang Wee; Jin Hak Lee; Mee Kum Kim

doi:10.3341/jkos.2011.52.1.97

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Lee, Heo, Wee, Lee, and Kim: A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation

Original Article

J Korean Ophthalmol Soc 2011;52(1):97-102.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.1.97

A Case of Endophthalmitis With Necrotizing Scleritis Treated With Vitrectomy and Permanent Amniotic Membrane Transplantation

Sang Yoon Lee, MD¹, Jang Won Heo, MD^1,², Won Ryang Wee, MD, PhD^1,², Jin Hak Lee, MD, PhD^1,³, Mee Kum Kim, MD, PhD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

³Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Address reprint requests to Mee Kum Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2665, Fax: 82-2-741-3187, E-mail: kmk9@snu.ac.kr

Received 3 August 2010 Revised 30 September 2010 Accepted 9 December 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of a patient with infectious endophthalmitis associated with necrotizing scleritis that was treated with pars plana vitrectomy and permanent amniotic membrane transplantation.

Case summary

A 76-year-old man with pain and visual loss in the right eye was diagnosed with infectious endophthalmitis and necrotizing scleritis. The visual acuity in the right eye was hand motion, and the slit lamp examination showed infection of the conjunctiva and sclera, corneal edema, hypopyon, and necrosis of nasal sclera. An intravitreal antibiotic injection was given, and Pseudomonas aeruginosa was cultured in vitreous fluid. Two days afterward, when vitrectomy was performed, leakage from the scleral microperforation and necrosis of the peripheral cornea was observed. Thus, a 10-layered permanent amniotic membrane transplantation was performed. The patient was given topical antibiotics and steroids, oral prednisolone, and cyclophosphamide postoperatively. After 74 days, endophthalmitis was remitted, and scleritis was well controlled. His visual acuity recovered to 20/40.

Conclusions

Infectious endophthalmitis due to scleral microperforation by necrotizing scleritis can be treated effectively with vitrectomy combined with permanent amniotic membrane transplantation.

Keywords: Amniotic membrane, Endophthalmitis, Scleritis

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Figure 1.

(A), (B), (C) The right eye at the first visit presented conjunctival injection, corneal edema, hypopyon, scleral edema, necrosis and thinning in nasal sclera, and epithelial defect in the nasal peripheral cornea. (D), (E) Ultrasonogram (B-scan) shows haziness in the vitreous and posterior sclera thickening at the first visit. (F), (G), (H) Amniotic membrane is intact in the necrotic nasal sclera 2 days after permanent amniotic membrane transplantation. White temporary amniotic membrane covered entire cornea and nasal conjunctiva. (I), (J), (K) At 74 days after treatment, conjunctival and scleral injection was nearly disappeared, and there is no epithelial defect in cornea and conjunctiva. (L), (M) Ultrasonogram (B-scan) shows a clear vitreous cavity and no posterior sclera thickening.

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