对疑为眼内炎患者房水玻璃体细菌培养结果的临床分析

目的 探讨眼内炎患者房水玻璃体培养细菌菌属的分布特点及其变化规律。 方法 对10年（1989～1998）间培养的522份眼内炎患者的房水玻璃体标本革兰氏染色，培养阳性细菌菌属分布及其变化规律进行回顾性分析。 结果 细菌培养标本522份（房水261份，玻璃体261份），培养阳性菌共119株（房水44株，玻璃体75株），平均培养阳性率为22.8%（房水阳性率为16.9%,玻璃体阳性率为28.7%）。培养阳性菌中，革兰氏阳性（G+）球菌54株占45.4%，G+杆菌24株，占20.2%，革兰氏阴性（G-）杆菌41株占34.5%。肠杆菌科比例最高占18.5%，其次为微球菌占16%，凝固酶阴性葡萄球菌占12.6%，假单胞属占10.9%。前后5年的比较结果显示，G+球菌的百分比变化不大，G+杆菌下降了13.9%，G-杆菌阳性增长了11.7%。 结论 G+球菌与G-杆菌仍是导致细菌性眼内炎主要菌属，后者比例近5年升高，这些变化应在临床诊治细菌性眼内炎时引起注意。 (中华眼底病杂志, 2002, 18: 104-105)     

白内障术毕应用聚维酮碘对术后眼内炎预防效果的研究

感染性眼内炎目前仍然是白内障摘除及人工晶状体植入术后的严重并发症之一,其发生率为0.06％～0.29％[1-5].感染性眼内炎是极具破坏性的最严重的并发症,一旦发生进展快,预后差,重者常致失明,甚至摘除眼球,因此预防白内障术后细菌性眼内炎的发生有重要意义.大量研究表明来自眼睑和结膜囊的菌群是引起术后眼内炎病原体的主要来源,这些细菌可以通过手术入路进入房水和玻璃体,成为引起眼内炎的危险因素.     

白内障超声乳化后铜绿假单胞菌眼内炎一例

眼内炎(endophthalmitis)是指眼球壁的一层或多层及相邻的眼内腔隙的感染性炎症.临床上指视网膜、脉络膜、玻璃体的潜在性破坏性炎症.白内障超声乳化术后细菌感染性眼内炎是一种少见但极为严重的并发症,其发生率为0.1％ ～0.31％.急性感染病例中,革兰氏阳性菌占90％,革兰氏阴性菌占7％.铜绿假单胞菌仅占革兰氏阴性菌感染的23％,但其感染性强,破坏力大,如处理不当往往严重损害视功能和眼内结构[1].现将我院所见1例白内障行超声乳化术后铜绿假单胞菌致急性感染性眼内炎报告如下: 1 病例     

127例外源性化脓性眼内炎病原体及药敏试验结果分析

目的：分析外源性化脓性眼内炎病原体及其对药物敏感性的变迁，为临床合理用药提供依据。方法：对127例(127眼)经临床诊断为化脓性眼内炎的前房水或玻璃体液标本进行涂片检查、细菌培养、真菌培养，对细菌培养阳性菌株进行药物敏感试验，然后对培养结果及药物敏感试验结果进行统计分析。结果：外源性化脓性眼内炎涂片阳性率为22．05％，细菌及真菌培养阳性率为42．52％。其主要致病菌为表皮葡萄球菌、枯草杆菌及铜绿假单孢杆菌。大多数细菌对环丙沙星敏感，对氯霉素、利福平、头孢唑琳耐药。结论：对化脓性眼内炎患者的前房水或玻璃体液进行涂片、培养及药物敏感试验有助于明确眼内炎的性质及指导临床用药的选择。     

山东省感染性眼内炎病原菌谱特点及药物敏感特征的临床研究

目的分析山东省感染性眼内炎的病原菌谱分布及药物敏感性特征。 方法回顾性分析2013年1月至2020年12月于山东第一医科大学附属眼科医院(山东省眼科医院)诊断为疑似感染性眼内炎350例(350只眼)患者的病例资料。其中,男性272例(272只眼),女性78例(78只眼);年龄1~87岁,平均年龄(44.4±20.0)岁。均为单眼发病。抽取所有患者的房水和(或)玻璃体(统称眼内液)进行涂片和体外培养实验。使用全自动微生物分析仪进行鉴定分离到的细菌和念珠菌,并行药物敏感性试验。采用WHONET5.6软件分析眼内炎患者的临床特点、病原菌分布以及主要病原菌的耐药性情况。感染性眼内炎病原菌分布和致病因素分布采用例数和百分比表示。 结果疑似感染性眼内炎350例患者中外源性眼内炎者和内源性眼内炎者分别为317例和33例,分别占90.6%和9.4%。房水和玻璃体均采集者269例,只采集房水者81例。涂片阳性者99例,阳性率为28.3%。涂片检出菌中革兰氏阳性球菌者、革兰氏阴性菌者、革兰氏阳性杆菌及真菌者分别为67例、8例、8例及16例,分别占67.7%、8.1%、8.1%及16.1%。病原微生物培养标本中病原菌阳性者135例,阳性率为38.6%,共分离得到病原菌144株。其中,革兰氏阳性球菌者、革兰氏阳性杆菌者、革兰氏阴性杆菌者及真菌者分别为87例、12例、15例及30例,分别占60.4%、8.3%、10.5%及20.8%。以眼内液涂片和(或)病原菌培养阳性为感染性眼内炎诊断的金标准,在350例全部疑似患者中,有211例患者眼内液涂片和(或)病原菌培养阳性,最终确诊为感染性眼内炎,感染阳性率为60.3%。病原菌中以凝固酶阴性的葡萄球菌居首位,其次为链球菌。真菌中主要以镰刀菌和曲霉菌为主。分离菌株对左氧氟沙星的敏感性最高达39.3%~84.6%。 结论2013年至2020年间,眼外伤是山东地区感染性眼内炎的主要致病因素,革兰氏阳性球菌尤其凝固酶阴性的葡萄球菌是感染性眼内炎的主要病原菌。     

白内障术后眼内炎的治疗分析

目的 探讨白内障术后眼内炎的治疗效果.方法 回顾性分析19例（19只眼）经临床和/或微生物检查证实为白内障术后眼内炎的临床资料.所有病例均行房水和玻璃体涂片和细菌/真菌培养＋药敏.结果 19例中术前有糖尿病史4例,高血压合并中度肾衰1例,泌尿系感染1例.19例中急性眼内炎16例,迟发性眼内炎3例.房水和玻璃体微生物检查阳性8例（阳性率42.11%）,其中球菌6例,杆菌1例,真菌1例.19例中15例行玻璃体切割联合玻璃体注药术,3例行前房冲洗和玻璃体注药术,1例行眼内容剜除术.14/15患眼炎症可控制,1例眼球萎缩外,16例保住眼球,最终视力＞0.05者9例.结论 白内障术后眼内炎及时有效的治疗可控制炎症,保留部分有用视力.     

静脉注射后环丙沙星在眼内炎及眼球穿通伤患者眼内的药物水平

目的 研究静脉注射后环丙沙星在眼内炎及眼球穿通伤患者眼内的药物水平.方法 老年性白内障对照组25例25眼、眼球穿通伤组21例21眼、眼内炎组12例12眼分别在白内障手术、玻璃体切割手术前1 h静脉注射环丙沙星,术中取房水或(和)玻璃体,双缩脲法测定房水蛋白含量,反向高效液相色谱法测定房水及玻璃体环丙沙星的浓度.结果 老年性白内障对照组、眼球穿通伤组及眼内炎组房水蛋白含量分别为(0.09±0.05)g·L-1、(2.31±1.71)g·L-1和(7.78±5.34)g·L-1,3组间比较差异均有显著统计学意义(P均<0.01);3组房水环丙沙星浓度分别为(0.18±0.07)mg·L-1、(0.19±0.08)mg·L-1和(0.52±0.18)mg·L-1,眼内炎组明显高于其他2组(P均<0.01),其他2组比较差异无统计学意义(P>0.05);玻璃体环丙沙星浓度眼内炎组为(0.50±0.38)mg·L-1,较眼球穿通伤组的(0.06±0.03)mg·L-1高(P均<0.01);眼内炎组房水和玻璃体中环丙沙星浓度与房水蛋白含量呈正相关(r=0.889和rs=0.841,P均<0.05).结论 眼内炎患者血-眼屏障通透性增高,静脉注射环丙沙星眼内渗透性增加,房水及玻璃体药物浓度可达大部分眼内致病菌最小抑菌浓度,可作为细菌性眼内炎治疗性用药.     

白内障术后感染性眼内炎治疗11例

目的探讨白内障术后感染性眼内炎相关因素及治疗方法。方法对我院1999年11月至2005年10月11例11眼白内障术后感染性眼内炎进行回顾性分析。结果7眼细菌培养阳性，培养细菌包括：表皮葡萄球菌2眼，粪肠球菌1眼，催产克雷白菌1眼，腐生葡萄球菌1眼，异型枸橼酸杆菌1眼，醋酸不动杆菌1眼。行后部玻璃体切割术者5眼，其中眼球摘除1眼；单纯前房冲洗加注药2眼；前房冲洗注药联合玻璃体腔注药4眼。结论前房和玻璃体注药，后部玻璃体切割术是治疗的有效方法。     

感染性眼内炎282例临床分析

目的 分析感染性眼内炎的病因和病原学特征，提高感染性眼内炎的认知和临床诊治水平。方法 回顾分析282例住院治疗的感染性眼内炎患者的临床和实验室检测资料。患者中，男性206例，占73.05%；女性76例，占26.95%。年龄最小2岁，最大79岁，平均年龄（36.0±11.2）岁。除14例病情较重，无法保存眼球者以外，其余268例患者进行了玻璃体标本的病原学检测。临床和实验室检查数据采用Chi-square检验和Kappa一致性检验方法进行统计学分析，以P＜0.05为差异有统计学意义。结果 282例感染性眼内炎患者中，眼外伤所致者177例，占62.77%；感染性角膜炎所致者61例，占21.63%；眼部手术后所致者32例，占11.35%；内源性眼内炎12例，占4.25%。不同病因所致的感染性眼内炎患者中，2～13岁者占眼外伤所致者的19.21%；14～50岁者占感染性角膜炎所致者的55.74%；51～79岁者占眼部手术后所致者的60.61%。病原体检测显示，真菌和葡萄球菌属各占30.63%，为本组感染性眼内炎患者的主要病原体。其中，致病细菌对环丙沙星敏感者最多，占81.81％；庆大霉素次之，占77.92％。结论 感染性眼内炎的主要致病因素是眼外伤，真菌和葡萄球菌属是导致眼内感染的主要病原体。明确感染性眼内炎的不同致病因素、病原学特征有助于提供恰当的临床治疗。     

玻璃体切除联合眼内注射万古霉素治疗白内障术后眼内炎

目的:观察玻璃体切除联合眼内注射万古霉素治疗白内障术后眼内炎疗效。方法:回顾性分析白内障术后并发感染性眼内炎患者11例11眼,观察其发生时间及房水、玻璃体细菌和真菌培养结果,经玻璃体切除后玻璃体腔内注射万古霉素,观察其眼部情况、最佳矫正视力。随访8mo～7a,平均28.6mo。结果:G+球菌4例,G-杆菌1例,病原菌检出率为45%。至随访结束术后视力提高2行以上的有9眼,占82%,视力无明显改变2眼,占18%;末次随访11眼玻璃体腔均清亮,无1例患者出现视网膜脱离等眼底并发症。结论:白内障术后眼内炎选择玻璃体切除术联合玻璃体腔内注射万古霉素是安全可靠的方法。     

Identification of bacterial pathogens in patients with endophthalmitis by 16S ribosomal DNA typing

PURPOSE: To determine whether sequence analysis of 16S ribosomal DNA (rDNA) can be used to detect bacterial pathogens in patients with postoperative endophthalmitis. METHODS: In 10 eyes of 10 patients, vitreous specimens were collected for culture and rDNA typing. Variable segments of each ribosomal DNA specimen were amplified by polymerase chain reaction (PCR), sequenced, and aligned by BLAST, a computer alignment program, against sequences in GenBank at the National Institutes of Health. RESULTS: Specimens were available from five eyes with bacterial endophthalmitis diagnosed by Gram stain or culture. Amplified 16s rDNA sequences from the eyes of three patients were identical to microbiologic results. Polymerase chain reaction results were negative in two cases in which unusual organisms were detected. All five control specimens from patients with nonbacterial endophthalmitis or uveitis were PCR negative. Approximately 48 to 72 hours are required under ideal conditions for final species identification with this ribosomal typing technique. CONCLUSIONS: 16S rDNA typing shows potential as a relatively rapid technique for identifying bacteria in vitreous samples.     

PCR-based evidence of bacterial involvement in eyes with suspected intraocular infection

PURPOSE: To assess the usefulness of polymerase chain reaction (PCR) in detection of bacteria in ocular samples. METHODS: Thirty-seven samples (aqueous and vitreous) were collected from 25 eyes showing typical symptoms and clinical signs of bacterial endophthalmitis. Ocular samples were also collected from 38 eyes that underwent routine surgery and from 15 eyes with intraocular inflammation due to nonbacterial causes. Panbacterial PCR was performed with a nested pair of 16S rRNA gene primers. Subsequent bacterial identification was completed for 18 paired samples (nine eyes) using restriction fragment length polymorphism (RFLP) and DNA sequencing. RESULTS: A 100% concordance was obtained between PCR and culture-positive samples. A PCR product was amplified from all 37 intraocular samples from eyes with suspected infection, whereas only 15 of 22 vitreous samples and 5 of 15 aqueous samples were culture positive. Culture-negative PCR-positive samples contained a preponderance of gram-negative bacterial sequences. Cloning and DNA analysis revealed 30 DNA sequences and included eight bacterial 16S rDNA, which currently remain unidentifiable. The presence of bacterial DNA was associated with an inflammatory response suggestive of infection and not colonization. All 15 samples from inflamed eyes with diverse uveitis diagnoses were PCR negative. The false-positive rate, due to contamination during sampling, was 5%. CONCLUSIONS: Bacterial DNA was detected in all patients with typical clinical signs of endophthalmitis. Gram-negative organisms seem to play a much more important role in the pathogenesis of this disease than previously thought. PCR-based techniques have great value in the confirmation of the diagnosis of bacterial endophthalmitis especially in culture-negative eyes.     

PCR-RFLP-mediated detection and speciation of bacterial species causing endophthalmitis

PURPOSE: To determine the usefulness of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in the identification and speciation of bacteria causing endophthalmitis. METHODS: PCR-RFLP was performed on 53 strains of 14 bacterial species (eight Gram positive and five Gram negative) collected from both keratitis and endophthalmitis patients. Two pairs of oligonucleotide primers based on the 16S rDNA gene were used to PCR-amplify 1.2- and 1.0-kb fragments of bacterial genomic DNA. RFLPs within the PCR product were used to speciate the organisms. RESULTS: The sensitivity of the nested PCR amplification reaction was one organism. All bacteria tested could be identified and speciated using RFLP analysis except for Escherichia coli and Serratia marcescens, which could not be interdifferentiated using RFLP. Molecular analysis of two vitreous samples from two eyes with typical signs of bacterial endophthalmitis confirmed the presence of E. coli in the vitreous from a culture-positive case with E. coli endophthalmitis and revealed the presence of Staphylococcus epidermidis in the vitreous of a culture-negative case. CONCLUSIONS: It is expected that this technique will provide a useful laboratory tool for future microbiologic diagnosis of patients presenting with endophthalmitis, especially for those eyes that prove culture negative.     

Application of polymerase chain reaction method (PCR) in diagnosis of endophthalmitis

PURPOSE: The goal of this study is to determine the usefulness of the PCR method in the diagnosis of endophthalmitis. MATERIALS AND METHODS: 30 clinical specimens 18 AH and 12 VF were obtained from 20 eyes with the clinical diagnosis of endophthalmitis. These included: 14 cases after cataract surgery, 1 case post trabeculectomy, 2 cases after penetrating traumas, and 3 cases after endogenous endophthalmitis. The same samples were analysed using 2 different methods: 1. conventional microbiological techniques (microscopy and diagnostic culture) and 2. PCR directed at 16S rDNA using universal primers. RESULTS: In the aqueous humor the causative pathogen was identified in one case (5.2%) by using diagnostic culture compared with seven cases (39%) by using PCR methods. In the vitreous samples the pathogen was identified in one case (9%) by using conventional method compared with five cases (50%) by using PCR. Microscopic preparation was difficult to evaluate in all samples. CONCLUSIONS: PCR performed on aqueous humor and vitreous fluid is a reliable tool for diagnosis of causative organism particularly in smear and culture negative specimens. By using universal primers we are able to detect the presence of pathogen in case of endophthalmitis and than potentially by using DNA probe hybridization to determine the species of the bacteria. The discrimination between infection or non-infection endophthalmitis plays the main role in a succesful therapy.     

玻璃体手术对内源性眼内炎的诊断及治疗

目的分析玻璃体手术对内源性眼内炎的诊断及治疗作用。方法对22例内源性眼内炎患者的诊断治疗进行回顾性分析，随访视力及预后情况。结果22 例患者中，21例进行血或玻璃体液涂片、培养，阳性率18例，占86％，其中细菌6例，真菌11例，1例为混合感染。16例有完整随访资料患者中，玻璃体手术成功13例，占81.3％，其中6例获得功能成功。结论玻璃体手术可以提高内源性眼内炎患者病源菌培养阳性率和视力预后。(中华眼底病杂志,2005,21:142-144)     

人工晶状体术后慢性细菌性眼内炎的治疗效果观察

目的 通过对白内障超声乳化摘除联合人工晶状体植入术后慢性细菌性眼内炎的治疗效果观察,提出治疗建议。方法 回顾分析2004-2009年收治的4例4眼人工晶状体术后慢性细菌性眼内炎,观察其发生时间、眼部体征。经平坦部玻璃体切除、晶状体后囊膜环形撕囊联合眼内注入万古霉素作为首选治疗方法。切除的玻璃体和撕下的晶状体后囊膜进行涂片和培养微生物检查。复发病例联合全身应用大环内酯类抗生素治疗。术后观察其眼部情况、视力。结果 4例平均发病时间是人工晶状体术后8周（5～11周）。其中女性3人、男性1人,年龄平均75岁（67～81岁）。玻璃体切除前视力分别是眼前手动1眼、数指2眼、1眼0.06。丙酸痤疮杆菌感染3跟,表皮葡萄球菌感染1眼。其中两眼分别于术后7周和5周复发。复发的两眼间断结膜下注射地塞米松和妥布霉素,联合全身应用罗红霉素和阿奇霉素8周,炎症控制。随访16～36月,无复发。最后随访眼部无炎症表现,晶状体囊膜清晰和玻璃体腔均清澈,最佳矫正视力分别是0.8、0.5、0.2和0.3。结论 人工晶状体植入术后慢性眼内炎玻璃体切除和晶状体后囊膜环形撕除术后,局部和全身应用抗生素时间要适当延长以防治复发,大环内酯类抗生素的治疗作用应受到重视。     

Experimental bacterial endophthalmitis following extracapsular lens extraction

The rapid increase in popularity of extracapsular cataract extraction may predispose the eye to postoperative bacterial infections by introducing viable organisms through the additional instrumentation and irrigation necessary for the extracapsular technique. Lens protein released into the aqueous humor of the anterior and posterior chambers may enhance or inhibit the ability of organisms to grow in the aqueous humor. In the intact eye the lens acts as a significant protective barrier restricting the posterior extension of the infectious processes. This study was undertaken to determine if extracapsular lens extraction enhances the ability of common bacteria to infect the anterior segment of the eye and if the posterior lens capsule acts as a protective barrier denying the infectious process access to the vitreous body. Approximately 1000 colony forming units (CFU) of Staphylococcus aureus were required to produce bacterial endophthalmitis in less than one-half of normal rabbit eyes and eyes following extracapsular lens extraction. Discission of the posterior lens capsule tripled the number of eyes infected. As few as fourteen CFU could produce infections in some eyes if the posterior capsule was incised. Extracapsular lens extraction does not predispose the eye to bacterial endophthalmitis if the posterior lens capsule remains intact. Interruption of the posterior lens capsule does allow a small number of organisms to establish an intraocular infective process. Lens protein and other constituents released into the aqueous humour appear to have little effect on the growth of the test organisms.