1Häring G., 2Wiechens B.

1Klinik für Ophthalmologie der Christian-Albrechts-Universität zu Kiel, Hegewischstr. 2, D-24105 Kiel; 2Klinikum Hannover Nordstadt, Augenklinik, Haltenhoffstr. 41, 30167 Hannover

Objective: Clostridium perfringens is a gram-positive anaerobic bacterium, which causes gas gangrene. Clostridium perfringens endophthalmitis is an extremely rare complication of penetrating eye injuries.
Patient: We report on a 37-years old patient who presented with a penetrating eye injury with intraocular foreign body. The injury happened 11 hours before while working with hammer and chisel at an agricultural machine. At presentation visual acuity was 1/7,5; the cornea showed a Seidel negative perforation of approximately 2 mm. Iris and lens were perforated, too. There was a localized vitreous hemorrhage, ophthalmoscopically an intraocular foreign body could not be identified. Intraocular inflammation was only mild. Computed tomography revealed a metallic foreign body within the vitreous. Surgical treatment was performed approximately 10 hours after admission to the hospital and included encircling band, lens extraction, pars plana-vitrectomy and C3F8-gas injection. Intraoperatively severe infiltration of the vitreous and retina was noticed. Microbiologically Clostridium perfringens was isolated. In spite of immediate appropriate antibiotic treatment visual acuity could not be preserved. Four months after the injury the eye became blind due to inoperable retinal detachment. Systemic complications did not occur.
Conclusions: Even when identified early, Clostridium perfringens endophthalmitis has a poor prognosis. Beside the ophthalmologic problems the possibility of systemic complications must always be kept in mind.

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