[Pars plana vitrectomy in Borrelia burgdorferi endophthalmitis].
BACKGROUND
Ocular manifestations of Lyme borreliose present with unusual forms of conjunctivitis, keratitis, optic nerve disease, uveitis, vitritis and rarely endophthalmitis.


METHODS
A 57-year-old man working as logger in Sax-ony-Anhalt suffering from an endophthalmitis on his left eye was referred to us. The vision of his left eye was intact light perception and hand motions. The slit-lamp examination revealed severe inflammation of the anterior chamber with hypopyon, posterior synechiae, and opacity of the posterior lens capsule. Funduscopy showed no red reflex, no retinal details. In the local hospital serum analysis was performed and showed in Western-Blot IgM- and IgG-antibodies against Borrelia burgdorferi. Despite of intravenous application of ceftriaxon for 14 days panuveitis persisted, and endophthalmitis developed when antibiotic therapy was finished.


RESULTS
During pars plana vitrectomy a sharply delineated cystic lesion containing yellowish fluid was revealed, and creamy yellow fluid was aspirated. Microscopically in hematoxylineosin stained slides of the aspirate structures consistent with Borrelia burgdorferi were found. Postoperatively vision increased to 1/15. Despite of a second intravenous ceftriaxon treatment for 14 days we observed a retinal vasculitis in the follow up of 6 months.


CONCLUSIONS
Despite intravenous ceftriaxon-therapy borrelia burgdorferi must have survived in the vitreous body. Further investigations are required with respect to the use of other antibiotics or immunosuppressives.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig.
P
P
Meier
R
R
Blatz
M
M
Gau
F B
FB
Spencker
P
P
Wiedemann
D015748:Borrelia burgdorferi Group / Q000187:drug effects; D002443:Ceftriaxone / Q000008:administration & dosage; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000601:surgery*; D017211:Treatment Failure; D014821:Vitrectomy
D002443:Ceftriaxone