백내장 수술 후 발생한 Enterococcus faecalis 재발성 안내염 2예 = Two Cases of Recurrent Enterococcus Faecalis Endophthalmitis after Cataract Surgery

국문 초록 (Abstract)

목적: Enterococcus faecalis (E. faecalis)에 의한 재발성 안내염 2예를 경험하였기에 보고하고자 한다.
증례요약: 증례1: 75세 여성이 백내장 수술 3일 후 발생한 우안 시력저하와 안구 통증으로 내원하였다. 안내염으로 진단하였고 안내 항생제 주사 후 염증이 조절되었으나 1달 후 재발하여, 유리체절제술을 시행하고 실리콘 기름과 항생제를 안내 주입하였다. 증례2:74세 여성이 백내장 수술 2일 후 발생한 우안 시력저하로 내원하였다. 안내염으로 진단하였고, 안내 항생제 주사 후 염증은 조절되었으나 1달 후 재발하여, 유리체절제술, 후낭절제술, 안내 항생제 주입술 시행하였고, 염증은 조절되었다. 유리체절제술 40일 후 다시재발하여 인공수정체를 제거하고, 실리콘 기름과 항생제를 안내 주입하였다. 두 증례 모두 첫 발생 및 재발에서 시행한 균 배양검사에서 각각 E. faecalis가 동정되었고, 안내 항생제는 vancomycin과 ceftazidime을 사용하였다. 증례 1은 이후 실리콘 기름을 제거하였고, 5개월 후 교정시력 20/400이었다. 증례 2는 이후 실리콘 기름을 제거하고 인공수정체 공막고정술을 시행하였으며, 5개월 후 최대교정시력은 20/40이었다.
결론: 백내장 수술 후 발생한 안내염의 원인균이 E. faecalis일 경우 감염이 조절된 후에 재발할 수 있음을 염두에 두어야 한다.

다국어 초록 (Multilingual Abstract)

Purpose: To report 2 cases of recurrent Enterococcus faecalis (E. faecalis) endophthalmitis after uneventful phacoemulsification and posterior chamber intraocular lens (IOL) implantation.
Case summary: Case 1: A healthy, 75-year-old female presented with a sudden visual loss and ocular pain 2 days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. At 1 month after the initial presentation, recurrent endophthalmitis occurred and was resolved with vitrectomy, silicon oil tamponade, and intravitreal antibiotics injection. Two months after vitrectomy, the silicone oil was removed and the patient’s final visual acuity improved to 20/400 5 months later. Case 2: A healthy, 74-year-old female presented with a sudden visual loss 2days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. One month later, recurrent endophthalmitis occurred and was resolved with vitrectomy, posterior capsulotomy,and intravitreal antibiotics injection. Forty days later, the patient had a similar relapse. The infection resolved with IOL explantation,
silicon oil tamponade, and repeated intravitreal antibiotics injections. E. faecalis was identified at the first and recurrent
episode. Vancomycin and ceftazidime were used for each intravitreal administration. Silicone oil removal and IOL scleral fixation were performed and the patient’s final visual acuity was 20/40 5 months later.
Conclusions: Close monitoring for recurrences is recommended in endophthalmitis due to E. faecalis after phacoemulsification even after a successful initial treatment.

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