ДВУХСТОРОННИЙ ГНОЙНЫЙ КЕРАТОСКЛЕРИТ, ВЫЗВАННЫЙ СИНЕГНОЙНОЙ ПАЛОЧКОЙ, У ПАЦИЕНТКИ В КОМЕ

Abstract

The article describes a clinical case of bilateral keratoscleritis caused by Ps. aeroginosa in a female patient suffering from occlusive hydrocephaly and intracranial hypertension with duration of coma and artificial pulmonary ventilation (APV) for 20 days. Materials and methods. At the moment of examination (in 7 days after purulent keratoscleritis started and rapidly progressed) the patient had lagophthalmos, purulent corneal ulcer, purulent xerotic sclera of OU, keratorrhexis of OS. On the same day directly in the intensive care unit, emergency penetrating sclerokeratoplasty was performed on OU in order to save eyes as organs. Forced instillations of antibiotics and antiseptics were used in the post-operative period. In 2 years 2 penetrating keratoplasties were performed in OD for optic purposes. Results. Emergency theurapetical penetrating sclerokeratoplasty with instillation of anterior segment and intraocular administration of a high dilution antibiotic were the only chance to save vision in OD. OS, where keratorrhexis developed due to advanced purulent sclerokeratitis and purulent iridocyclitis was lost despite all the efforts. After three surgeries (sclerokeratoplasty and 2 keratoplasties) vision acuity in the only right eye makes 0.1, which can be regarded as a satisfactory outcome. Conclusions. A malicious course of the disease, peracute progress and extremely severe consequences are typical of the advanced corneal ulcer caused by Ps. aeroginosa. Special attention is to be paid to the eyes of patients being in an intensive care unit in a coma and having continuous artificial pulmonary ventilation due to the high risk of developing purulent corneal ulcer and eye loss.