庆大霉素结膜下注射误入球内并误诊为视网膜中央动脉阻塞一例

目的:报道一例因庆大霉素球结膜下注射误入眼球内并误诊为视网膜中央动脉阻塞的病例。方法:给予一系列的检查包括:眼底检查、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)后确诊,患者进行玻璃体切割术治疗。结果:FFA提示后极部视网膜血管严重充血缺损,确诊为药物毒性视网膜病变后(庆大霉素性)给予玻璃体切除手术,术后视力为指数/1m。随访期间发现眼压偏高,出现巩膜葡萄肿,视神经萎缩。结论:庆大霉素误入球内多为操作失误所致,大剂量的药物可对视网膜产生严重的毒性反应,并可误诊为视网膜中央动脉阻塞,需高度警惕,FFA可帮助诊断。玻璃体手术虽不能改变视网膜的根本损害,但可以降低药物浓度,恢复病人的一些有用视力。

A Case Report of Injecting Gentamicin Intraocularly by Mistake Being Misdiagnosed as Central Retinal Artery Occlusion

PURPOSE: To report a case receiving gentamicin injection intraocularly by mistake when subconjunctival injection and was misdiagnosed as central retinal artery occlusion. METHODS: After a complete examination, including ocular fundus examination, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA), the correct diagnosis was confirmed.The patient received a surgery of vitrectomy. RESULTS: FFA revealed severe retinal vascular nonperfusion of the posterior pole.The final diagnosis was medicine toxic retinopathy from gentamicin.The visual acuity of the patient was counting figure/1 meter postoperationally. High intraocular pressure, scleral staphyloma and optic atrophy were detected during the follow-up. CONCLUSION: Injecting gentamicin intraocularly by accident usually resulted from carelessness.The massive doses of gentamicin might result in the severe retinal damage, which could be misdiagnosed as central retinal artery occlusion.Much attention should be paid to avoid its occurrence.The examination of FFA can help make correct diagnosis.Through the vitrectomy, though the damage could't be reversed thorougly, the surgery of vitrectomy could resume a little effective vision for the patient.