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Computer-aided diagnosis of incomplete muscle paralysis of a single vertical

Diagnosis: left corner of the scleral penetrating injury, anterior chamber vitreous hemorrhage, traumatic cataract, intraocular foreign body. Emergency local anesthesia magnetic intraocular foreign bodies left scleral repair + surgery + + previous section cataract aspiration vitrectomy. Intraoperative see corneoscleral penetrating mouth horizontal direction, about long-12mm, smooth metallic foreign body aspiration. Tobramycin solution are washed before and after surgery and conjunctival wound, after tobramycin 160,000 U, intravenous dexamethasone 10mg, Ofloxacin 0.2Bid oral, local Code will be comfortable q2h eye. Check the morning of postoperative day 1 no significant risk of ocular inflammation, anterior chamber of a small air bubble, at day suffer from eye pain, aggravated at night. Left eye was found the next day suppurative endophthalmitis performance, a high degree of eyelid edema, conjunctival edema, corneal edema, opacity, anterior chamber yellow pus, eyes can not see into. The bacterial culture collected aqueous humor to send additional sensitivity test, suspected Pseudomonas aeruginosa infection, to the eye and subconjunctival injection of bacteria Bristol, Bristol intravenous bacteria, amikacin and dexamethasone. Check blood WBC12 ~ 14X10 / L. Recognizing the anterior chamber on day 1 after a small bubble, but also occurred at 24h severe purulent endophthalmitis, do not rule out the possibility of anaerobic infection, then increase the metronidazole oral, high-dose intravenous penicillin, muscle injection of tetanus antitoxin, hormone reduction, stop amikacin. 2 days after the inflammation a little relief, that is, vitrectomy surgery to remove a lot of pus and blood liquid, try to clean up corneoscleral penetrating adhesion in the mouth and a large number of iris yellow pus moss ball injection of cefazolin 0.1. Postoperative inflammation control, symptom relief, corneal edema, wound healing. Visual acuity was light perception eyes. Bacterial culture: in the blood agar medium and poor growth broth, 5 days a preliminary report on gram-positive bacteria. Change the culture of anaerobic bacteria grow well, the results of the first 14 days of Bacillus perfringens shuttle Author: 361001 Xiamen, Xiamen Eye Center Corresponding author: Liu Zhixiong clinical report of bacteria, vancomycin and kanamycin sensitive. The results of the initial guidance of treatment has been lost, but eventually used to show drug-sensitive bacteria. 19 days after hospitalization, the patient was discharged, discharge suspicious light perception left eye vision. B-Tip left eye axial length 18.6mm, vitreous opacity. 1 week after discharge review, see the original corneal surface through openings and iris neovascularization, intraocular pressure measurement refers to a T,[link widoczny dla zalogowanych], no light perception vision. Half underwent enucleation combined hydroxyapatite orbital implant. See eyeball atrophy after surgery, retinal detachment showed a bundle. Discussion: With the improved anaerobic culture techniques, eye infections caused by anaerobic bacteria gradually be taken seriously. Widespread anaerobic bacteria in the natural environment. Anaerobic bacteria isolated normal eye conjunctival sac rate 32.5% ~ 51.6%, is generally not pathogenic, but under certain conditions, partial or aerobic, facultative anaerobes mixed infections are pathogenic. Exogenous infectious endophthalmitis is more common aerobic bacteria, anaerobic bacteria and fungi _1.2 few as】. The patients with primary infection from eye intraocular metallic foreign body, mixed with dirt and oil, therefore, anaerobic bacteria were most likely hidden. 6 hours after injury in patients with emergency hospital, 2 hours after operation to remove the foreign body, and that occurred within 24 hours of severe endophthalmitis. Patients with systemic symptoms, white blood cells increased. This case is a special performance found in the anterior chamber on postoperative day 1 the top of a small bubble,[link widoczny dla zalogowanych], although I realize that can not rule out the possibility of anaerobic infection, and give metronidazole, intramuscular injection of tetanus antitoxin and large doses of penicillin control inflammation,[link widoczny dla zalogowanych], surgical removal of vitreous and wear eye purulent material on the channel, but failed to rescue visual function in affected eyes. Bacterial toxin that strong, vigilance is still not enough. With the improvement of anaerobic culture techniques. Eye infection caused by anaerobic bacteria should be taken seriously. Because the eye of such bacteria are the most destructive bacteria, can release a variety of enzymes and exotoxin, ocular injury infection or mixed infection of the bacteria, often within 24 hours of ocular tissues caused irreparable damage. Therefore, for such bacterial infections, the key is prevention and early effective treatment in the emergency line should be penetrating eye injuries repair and take the specimens sent to foreign surgery increases susceptibility of bacterial culture, anaerobic culture is best done at the same time, and preventive eye injection of antibiotics. Under aerobic conditions in this case the blood agar plate growth in poor parts of the growth in the broth. Initially identified as Gram positive bacteria; later converted into anaerobic culture is clearly infected with Clostridium perfringens spores, but the drug has lost its early significance.
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