ABSTRACT

An 82-year-old woman with macular degeneration receiving intravitreal bevacizumab, presented with 5-months history of muco-purulent blepharo-kerato-conjunctivitis, resistant to multiple topical antibiotics. Visual acuities were 20/25 right and 20/30 left. She had patent nasolacrimal systems, bilateral blepharoptosis, deep superior fornices (21mm right, 22mm left) with muco-purulent discharge, upper tarsal papillae, and punctate keratitis. Bilateral giant fornix syndrome (GFS) was diagnosed, and forniceal swabs grew Serratia marcescens and Pseudomonas aeruginosa, despite current use of intensive topical moxifloxacin. Topical preservative-free Povidone-Iodine 5% twice-daily, two-hourly weaning course of Prednisolone acetate 1% and Ciprofloxacin 250 mg twice-daily were added with complete resolution within 1 week and no recurrence after 3 months. Serratia conjunctivitis has not been previously reported in association with GFS. Conjunctival flora alteration following previous peri-procedural antibiotics and antiseptics, in the setting of a large fornix with redundant, inflamed conjunctiva, may explain the colonization with this opportunistic organism. Topical povidone-iodine 5% appears to be effective for multi-drug resistant opportunistic Serratia conjunctivitis in association with GFS.

摘要

一位 82 岁的黄斑变性女性接受玻璃体腔注射贝伐珠单抗治疗，有 5 个月的黏液化脓性睑角化结膜炎病史，对多种局部抗生素有耐药性。视力为右眼 20/25 和左眼 20/30。她有鼻泪管系统未闭、双侧上睑下垂、深上穹窿（右侧 21 毫米，左侧 22 毫米）伴粘液脓性分泌物、上睑板乳头和点状角膜炎。确诊双侧巨穹窿综合征（GFS），穹窿拭子长粘质沙雷氏菌和铜绿假单胞菌，尽管目前使用强化外用莫西沙星。外用不含防腐剂的聚维酮碘 5% 每天两次，每两小时停药一次，加入 1% 醋酸泼尼松龙和环丙沙星 250 mg 每天两次，在 1 周内完全消退，3 个月后无复发。沙雷氏菌结膜炎以前没有与 GFS 相关的报道。之前围手术期使用抗生素和防腐剂后结膜菌群发生改变，在大穹窿伴有多余的发炎结膜的情况下，可能解释了这种机会性生物体的定植。外用聚维酮碘 5% 似乎对与 GFS 相关的多重耐药性机会性沙雷氏菌结膜炎有效。