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1.
重度眼球破裂急诊眼球摘除的临床分析   总被引:1,自引:0,他引:1  
目的 探讨在重度眼球破裂的复杂情况下如何严格掌握眼球摘除的适应证。方法 对55例55眼在急诊情况下摘除眼球作了回顾性分析。结果 55眼由于重度眼球破裂而作了眼球摘除或眼内容摘除。结论 在眼球重度破裂伤后出现视力无光感,眼球巨大伤口、眼内容物大量脱出、眼球严重塌陷已无法维持基本的形状,合并眼内容物脱出后全眼球活动性出血、眼内巨大异物,眼内炎等应考虑急诊摘除眼球。  相似文献   

2.
169例感染性眼内炎病因分析   总被引:9,自引:2,他引:9  
目的 探讨感染性眼内炎的致病原因和危险因素。方法 对我院1996年10月~2002年10月连续治疗的169例感染性眼内炎患者的临床资料进行回顾性分析。内容包括发病原因、年龄、病程、治疗和预后情况。结果 致病因素:外伤136例136只眼,内眼手术11例11只眼,转移性17例18只眼,暴露性角膜炎角膜穿孔5例5只眼。104例105只眼行玻璃体切割手术,27例27只眼行眼球摘除或眼球内容物剜出,23例23只眼行缝合伤口或外路异物取出加药物治疗,12例12只眼单纯行药物治疗,5例5只眼放弃玻璃体切割而自动出院。治疗结果:视力无光感13只眼,光感34只眼,手动36只眼,数指22只眼,0.02~0.19只眼,0.1~0.25只眼,0.2~0.33只眼,0.3~0.45只眼,0.4~0.53只眼,0.5~0.63只眼,0.81只眼,因患儿年幼不认识视力8只眼,27例单眼无眼球。随访1月~60个月,平均9月,68只眼球萎缩。结论 眼外伤是感染性眼内炎的主要致病因素,重在预防。随着玻璃体切割手术和球内注射抗生素的应用,感染性眼内炎的预后有所改善。但早期诊断、及时有效的治疗是保存患眼,挽救视力的关键。  相似文献   

3.
目的分析眼内容剜出的病理学分类以进一步探讨眼内容剜出的原因。方法对本院2001年1月至2007年8月眼病理室存档的22例(22只眼)眼内容剜出病例进行临床分析及组织病理学分析。结果感染性眼内炎12例(54.55%),其中真菌性眼内炎7例;眼球萎缩7例(31.82%);角巩膜葡萄肿2例(9.09%);绝对期青光眼1例(4.55%)。结论感染性眼内炎尤其是真菌性眼内炎是眼内容剜出的首要原因,早期正确的诊治可避免眼内容剜出。  相似文献   

4.
开放性眼外伤玻璃体切除术后眼球摘除23例临床分析   总被引:2,自引:0,他引:2  
目的 探讨开放性眼外伤玻璃体切除术后眼球摘除的原因和相关危险因素.方法 回顾性分析1997年1月至2007年1月收治的开放性眼外伤玻璃体切除术后眼球摘除23例(23只眼)患者的临床资料,采用Logistic多因素分析法筛选危险因素.结果 眼球摘除的原因:玻璃体切除术后视网膜脱离复发19只眼,玻璃体切除术中视网膜复位不良2只眼,外伤性眼内容炎不能控制1只眼,玻璃体切除术后玻璃体出血药物治疗长期不能吸收1只眼.眼外伤时伤口大小、有无异物伤、有无眼内炎、PVR分级、眼球摘除前视力、手术次数与眼球摘除相关.结论 开放性眼外伤玻璃体切除术后眼球摘除的危险因素为外伤时伤口长大于10mm、伴异物或眼内炎,玻璃体切除时PVR分级C2或以上,眼球摘除前视力无光感,眼球摘除前手术次数≥3次.  相似文献   

5.
玻璃体切割术治疗眼内炎的临床分析   总被引:14,自引:2,他引:12  
目的 探讨眼内炎的病因构成及玻璃体切割术治疗眼内炎的临床效果。 方法 对我院1999年1月~2001年12月收治的眼内炎患者53例54只眼进行回顾性分析,男38例,女15例,年龄1~74岁,平均年龄32岁。对2例(2只眼)炎症较轻的患者仅采用药物治疗,5例(5只眼)视力无光感,炎症反应重的患者行眼球内容物剜除术,其余46例(47只眼)均采用常规三通道玻璃体切割术。随访2~32个月,平均10.5个月。 结果 眼球穿通伤导致的眼内炎共32只眼,占59.26%。内源性眼内炎8只眼,占14.81%。与白内障手术相关的眼内炎共7 只眼,占12.96%,青光眼手术晚期滤泡感染2只眼,占3.70%。玻璃体切割术后3只眼,占5 .56%。放射状角膜切开术(radial keratotomy,RK)后1只眼,占1.85%。原因不明1只眼,占1.85%。经治疗后患者视力明显提高(P=0.003)。3 d内行玻璃体切割术患者的视力恢复明显高于3 d后的患者(P=0.014),7 d内行玻璃体切割术患者的视力恢复明显优于7 d后的患者(P=0.021)。功能成功(视力≥0.02)37只眼,占68.52%;解剖成功(视力<0.02,眼球结构完整)47只眼,占87.04%,脱盲(视力≥0.05)27只眼, 占50.00%。 结论 眼球穿通伤,尤其是伴有眼内异物存留者是导致眼内炎的最主要原因,尽早行玻璃体切割术是治疗眼内炎的理想方法。 (中华眼底病杂志,2003,19:93-95)  相似文献   

6.
目的 对感染性眼内炎的致病原因、临床诊治及其特点进行分析,为该病的防治提供参考资料。方法 对2014年1月至2017年6月诊治于南昌大学第二附属医院的193例(193眼)感染性眼内炎患者进行回顾性分析,统计患者的致病因素、病原学、治疗及预后等特点。结果 所有患者中外伤性眼内炎137例(71.0%),铁器类、木制品和物体类是致病的主要原因;眼部手术后感染性眼内炎35例(18.1%),以白内障和青光眼术后为主;内源性眼内炎15例(7.8%),以不明原因的病例为主;感染性角膜炎导致者6例(3.1%)。181例患者病原菌培养阳性率为13.3%,以凝固酶阴性葡萄球菌和草绿色链球菌为主要病原菌。眼部手术后及内源性眼内炎患者合并有糖尿病和(或)高血压易感因素的比例较高,玻璃体切割术是主要的治疗方式。感染性眼内炎患者治疗前最佳矫正视力无光感~0.02者占比为86.2%,治疗后无光感~0.02者占比为62.9%、≥0.10者占比为24.9%,差异有统计学意义(P<0.001);其中治疗前后视力有统计学差异的是外伤性及眼部手术后患者,内源性眼内炎患者治疗前后视力比较无统计学差异。感染性角膜炎导致者视力大部分无光感。结论 外伤性和眼部手术后眼内炎是感染性眼内炎的两种主要类型,玻璃体切割术是主要的治疗手段。感染性眼内炎经不同的方式积极治疗后可以控制感染,改善视功能。  相似文献   

7.
目的 探讨白内障摘除术后感染性眼内炎的手术治疗方法并评价其疗效.方法 对2006年9月至2007年8月间从外院转来的行白内障摘除、人工晶状体植入术后并发感染性眼内炎的6例7只眼.其中5例6只眼为经巩膜隧道的小切口白内障囊外摘除术,1例1只眼为超声乳化手术.采取显微玻璃体切除、眼内激光光凝及眼内硅油填充.结果 随访1~6月.随访时6只眼眼前节无异常,视网膜平伏,视力提高;1只眼因细菌毒力过强,眼内组织损伤严重而无光感,但眼球得以保留.结论 白内障术后感染性眼内炎是一种严重的手术并发症,治疗不及时,视功能将受到不可逆的损害.应用玻璃体切除联合硅油填充,可使眼内炎得到有效控制,最大限度的保存视力和保留眼球.  相似文献   

8.
目的 探讨感染性眼内炎病因、病原、治疗方法及治疗结果.方法:感染性眼内炎12例(12眼).对其性别、年龄、致伤物、病原学、诊疗方案、治疗结果等进行回顾性分析.结果:12例中1例行眼球摘除术,1例拒绝手术、行保守治疗后眼球萎缩,10例行玻璃体切除手术.行玻璃体切除术者中,1例眼内巨大异物包裹未摘、随诊期间眼球萎缩;1例为真菌性眼内炎随诊期间眼球萎缩;其余8例均保留眼球挽救了部分视力(光感至0.3).眼内液培养结果1例培养出施氏葡萄球菌施氏亚种,2例培养出曲霉菌,7例培养未检出细菌及真菌,1例眼球摘除未行培养,1例保守治疗未行培养.结论 对于确诊或高度怀疑眼内炎,经玻璃体腔注射药物及全身抗生素应用无缓解者,需尽早行玻璃体切除手术清除玻璃体炎性病灶,玻璃体切除术可最大限度挽救患者眼球及保留部分视力.  相似文献   

9.
眼内炎     
眼内炎可以分为感染性(或细菌性)及无菌性两种。眼内感染既可因身体其它处病灶经血流转移引起,又是内眼手术及穿孔性眼外伤最严重的并发症。近年来,因激素使用的增加及人工晶体植入术的开展,感染性眼内炎在临床上并不少见。本病一旦发生,患眼不但可能失去视力,而且还有丧失眼球的危险。本文着重综述由眼内手术及穿孔性眼外伤所引起的感染性眼内炎(以下简称眼内炎)的研究近况。一、临床上眼内炎发生的概况(一)白内障手术后的感染发生率  相似文献   

10.
万金兰  陈震 《国际眼科杂志》2013,13(11):2314-2316
目的:探讨感染性眼内炎行玻璃体切除治疗时,保留和摘除透明晶状体时的临床疗效比较。方法:将34例34眼患者随机分为两组,保留透明晶状体组(15例):行玻璃体切除时保留透明晶状体;摘除透明晶状体组(19例):行玻璃体切除时摘除透明晶状体。术后均随访6~12mo,分析透明晶状体不同处理方法时术后视力(矫正后)及眼部一般情况。结果:保留透明晶状体组,视力提高14眼,视力提高为93%;摘除透明晶状体组,视力提高18眼,视力提高为95%。保留透明晶状体组,1眼眼内炎未能控制,为7%;摘除透明晶状体组,1眼眼内炎未能控制,为5%。两组比较差异无显著性(P>0.05)。术后随访6~12mo,两组均无眼内炎复发病例。结论:感染性眼内炎玻璃体切除时保留和摘除透明晶状体临床疗效无明显差异。  相似文献   

11.
Risk factors in endophthalmitis leading to evisceration or enucleation   总被引:2,自引:0,他引:2  
BACKGROUND AND OBJECTIVE: This study aimed to evaluate the risk factors associated with evisceration or enucleation in endophthalmitis cases. PATIENTS AND METHODS: A retrospective analysis was conducted of all cases of endophthalmitis in a single unit over a 10-year period. The cases were divided into two groups. The group 1 consisted of patients with endophthalmitis who underwent evisceration or enucleation. The group 2 included patients with endophthalmitis who recovered with intravitreal injection or vitrectomy. RESULTS: During the 10-year study period, 86 patients with endophthalmitis were admitted for treatment. Evisceration or enucleation was undergone by 20 patients (23.2%) (Group 1); Group 2 consisted of 66 patients. Older age (P = 0.03), no light perception at presentation (P < 0.0001), endophthalmitis associated with corneal ulcer (P < 0.0001), and endogenous endophthalmitis (P = 0.048) were statistically significant factors associated with the need for evisceration or enucleation.  相似文献   

12.
Eifrig CW  Scott IU  Flynn HW  Miller D 《Ophthalmology》2003,110(9):1714-1717
OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.  相似文献   

13.
Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05–1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04–1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.Subject terms: Retinal diseases, Glaucoma  相似文献   

14.
PURPOSE: To describe metallic intraocular foreign body (IOFB) injuries and identify prognostic factors for visual outcome and globe survival. DESIGN: Interventional, consecutive, retrospective case series. METHODS: setting: Wills Eye Hospital. study population: Ninety-six eyes of 96 patients with metallic intraocular foreign bodies. procedures: Metallic IOFB injuries between January 1991 to June 2002 were reviewed for clinical characteristics, surgical intervention, and outcome. Univariate and multivariate analyses were performed to identify prognostic variables. main outcome measures: Final visual acuity and globe survival. RESULTS: The average patient age was 33.0 years with a male predominance (94%). Forty percent of eyes had a presenting vision of 20/50 or better. Following IOFB removal, 40% of patients required additional interventions. Thirty-one percent of eyes had a final acuity of 20/50 or better. Eight percent of patients ultimately required enucleation or evisceration. Excellent visual outcome (defined as > or =20/50) was associated with multiple variables, including normal lens at presentation and anterior segment IOFB (P< .003). Factors associated with poor visual outcome (defined as <20/200) included uveal prolapse and posterior segment IOFB (P < .0003). Globe loss was associated with younger age, presenting light perception (LP) or no light perception (NLP) vision, BB/pellet injury, and the presence of an afferent pupillary defect (P < .01). CONCLUSIONS: Multiple prognostic factors were identified in this large analysis of metallic IOFB injuries, which may help predict visual outcome and globe survival. Most of these variables were independent of intervention and can be identified at the time of initial presentation.  相似文献   

15.
ABSTRACT: BACKGROUND: An eye injury that causes no light perception (NLP) typically carries an unfavorable prognosis, and NLP because of trauma is a common indication for enucleation. With advances in vitreoretinal surgical techniques, however, the indication for enucleation is no longer determined by posttrauma NLP vision alone. There are limited studies in the literature to analyse the outcome of NLP eyes following open globe injury. The current study was aimed to evaluate the outcome of surgical repair of severely traumatized eyes with no light perception vision as preoperative visual acuity. Secondary objective was to possibly predict the factors affecting the final vision outcome in this eyes. METHODS: Retrospective case analysis of patients with surgical repair of open globe injury over last ten years at a tertiary referral eye care centre in Singapore. RESULTS: Out of one hundred and seventy two eyes with open globe injury 27 (15.7 %) eyes had no light perception (NLP). After surgical repair, final visual acuity remained NLP in 18 (66.7 %) eyes. Final vision improved to Light perception/ Hand movement (LP/HM) in 2(7.4 %) eyes, 1/200 to 19/200(11.1 %) in 3 eyes and 20/50-20/200(14.8 %) in 4 eyes. The median follow up was 18.9 months (range: 4-60 months). The factors contributing to poor postoperative outcome were presence of RAPD (p = 0.014), wound extending into zone III (p = 0.023) and associated vitreoretinal trauma (p = 0.008). CONCLUSIONS: One third of eyes had ambulatory vision or better though two third of eyes still remained NLP. Pre-operative visual acuity of NLP should not be an indication for primary enucleation or evisceration for severely traumatized eyes. Presence of afferent papillary defect, wound extending posterior to rectus insertion and associated vitreoretinal trauma can adversely affect the outcome in severely traumatized eyes with NLP. Timely intervention and state of art surgery may restore useful vision in severely traumatized eyes.  相似文献   

16.
Purpose: To investigate clinical settings, treatments, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Citrobacter species. Methods: Data were collected for organisms, surgical intervention, antibiotic sensitivity patterns, and final visual acuity. Results: Six eyes of 6 patients with culture-proven C. freundii (n = 4) or C. koseri(n = 2) endophthalmitis were identified. Clinical settings included cataract surgery (1 eye), cataract surgery combined with trabeculectomy (1), trauma (2), penetrating keratoplasty (1), and presumably endogenous source (1). Primary or secondary evisceration was performed in 3 eyes. Initial pars plana vitrectomy with intravitreal antibiotics was performed in 3 eyes. Final visual acuity was no light perception in 5 eyes, and 1 patient with traumatic C. koseri endophthalmitis achieved a final vision of 20/30. Conclusion: Despite treatment with appropriate antibiotics, Citrobacter endophthalmitis can be associated with a poor visual outcome. Early detection and management may improve the final visual outcome and prevent the possibility of evisceration.  相似文献   

17.

Purpose

To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs).

Methods

Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre.

Results

In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20–42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4–34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05).

Conclusion

Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.  相似文献   

18.
PURPOSE: To study the clinico-microbiologic profile and visual prognosis of ocular injuries caused by disposable hypodermic needles used by children to squirt water. METHODS: We analyzed 19 consecutive cases of hypodermic needle injury seen at our institute. RESULTS: The average age of the patients was 10.3 years (range, 4-20 years). A small self-sealed corneal or scleral laceration was seen in 11 eyes; in 8 eyes, the site of injury was occult. Initial visual acuity was no light perception (3 eyes) or hand motion or light perception (16 eyes). Surgery in 18/19 eyes included vitrectomy with intraocular antibiotic injections for endophthalmitis (14 eyes), evisceration for panophthalmitis (2 eyes), and cataract extraction for traumatic cataract (2 eyes). Final visual acuity was no light perception or light perception only in 10 eyes, 20/400-20/60 in three eyes, and 20/40 or better in six eyes. CONCLUSIONS: Severe ocular morbidity may result from improper disposal of hypodermic needles.  相似文献   

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