ABSTRACT
PURPOSE: To report a case of post-traumatic infectious endophthalmitis caused by Clostridium tetani and Bacillus spp. METHODS: Case report. RESULTS: A 25-year-old man developed endophthalmitis after a traumatic corneoscleral laceration of his right eye by a concrete reinforcement bar. He underwent pars plana lensectomy and vitrectomy with aspiration of vitreous fluid and a conjunctival swab for cultures. Cultures from the conjunctival swab were negative for organisms. Cultures of the vitreous aspirate were positive for Bacillus species and C. tetani. He had received a tetanus toxoid booster at the emergency department. By the time the culture results became available, he had developed severe eye pain associated with marked orbital congestion, increased swelling and erythema of the lids, marked injection and chemosis of the conjunctiva, and subsequently underwent evisceration. The inflammation resolved after evisceration of the right eye, and he was discharged to home on doxycycline 100 mg orally two times daily for 10 days. CONCLUSION: We are unaware of previous reports of endophthalmitis involving C tetani and could find none in a computerized MEDLINE search. Patients with penetrating eye injury should be assessed for tetanus immunization status, and early intervention with tetanus toxoid booster and/or tetanus immune globulin should be considered if cultures are positive.
Subject(s)
Bacillus/isolation & purification , Clostridium tetani/isolation & purification , Corneal Injuries , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Eye Injuries, Penetrating/microbiology , Sclera/injuries , Tetanus/microbiology , Adult , Cataract Extraction , Endophthalmitis/diagnosis , Endophthalmitis/surgery , Eye Evisceration , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/surgery , Eye Injuries, Penetrating/diagnosis , Eye Injuries, Penetrating/surgery , Humans , Male , Rupture , Tetanus/diagnosis , Tetanus/surgery , Vitrectomy , Vitreous Body/microbiologyABSTRACT
In a clinical study, 61 patients underwent phacoemulsification with subsequent intraocular lens (IOL) implantation. An intercapsular capsulotomy with phacoemulsification was performed on 23 patients and a can opener capsulotomy with phacoemulsification on 38 patients. Wide-field specular microscopy was performed preoperatively and postoperatively on all of the eyes in the study. The cell counts were not divulged to the surgeon before or at the time of surgery. Average endothelial cell loss for the intercapsular technique was 3.9%; with the can opener technique, the average cell loss was 10.1%. This difference was statistically significant (P less than 0.01). Positive correlations between endothelial cell loss relating to ultrasound time and/or the hardness of the cataract existed for the can opener group only (P less than 0.01). These results demonstrate that a protective effect is provided by the presence of the anterior lens capsule during lens substance removal.
