盐酸万古霉素综合方案治疗眼内炎

目的：探讨盐酸万古霉素综合方案治疗眼内炎的临床疗效和并发症。 方法：收集我院2009-07/2011-08眼内炎住院患者27例27眼,采用盐酸万古霉素综合治疗方案进行治疗。所有患者取玻璃体做细菌培养和药敏试验。采用玻璃体腔内注射盐酸万古霉素,全身使用盐酸万古霉素联合左旋氧氟沙星。炎症无明显好转者,2~4d后行玻璃体切割术,术中使用含盐酸万古霉素的灌注液。术后观察视力、眼压、前房和玻璃体混浊情况。对术后最佳矫正视力和眼压进行统计学分析。 结果：患者27例眼内炎均治愈,视力均有提高。细菌培养检出率56%。革兰氏阳性菌占67%,对盐酸万古霉素敏感。革兰氏阴性菌对氧氟沙星较敏感。8例患者经过静脉滴注及玻璃体腔内注药后眼内炎症控制,19例行玻璃体切割手术。术后最佳矫正视力提高。临床症状体征好转。 结论：早期细菌培养对眼内炎的治疗有重要意义。盐酸万古霉素综合治疗方案能有效治疗眼内炎。     

Endogenous Endophthalmitis Caused by ST66-K2 Hypervirulent Klebsiella pneumoniae,United States

We describe a case of endogenous endophthalmitis caused by sequence type 66-K2 hypervirulent Klebsiella pneumoniae in a diabetic patient with no travel history outside the United States. Genomic analysis showed the pathogen has remained highly conserved, retaining >98% genetic similarity to the original strain described in Indonesia in 1935.     

Endophthalmitis after intravitreal injections

Endophthalmitis following intravitreal injection is an infrequent but serious clinical problem. Infectious endophthalmitis must be differentiated from noninfectious inflammation. Depending on the series, the risk of endophthalmitis is very low. The use of a standardized injection protocol can reduce the risk of infection.     

外伤性兔眼内炎房水中肿瘤坏死因子-α、白细胞介素-1β及中性粒细胞趋化因子-1的相对含量变化及意义

目的 通过分析兔眼外伤后不同时间点房水中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)、中性粒细胞趋化因子-1(cytokine induced neutrophil chemoattractant-1,CINC-1)含量的动态变化,探讨促炎细胞因子在外伤性眼内炎中的作用机制.方法 将18只兔随机分为3组,每组6只,其中Ⅰ组为正常对照组,Ⅱ组为无菌外伤组,Ⅲ组为有菌(金黄色葡萄球菌)外伤组.Ⅱ组和Ⅲ组兔右眼建立外伤性眼内炎模型,并将金黄色葡萄球菌接种于Ⅲ组兔右眼的玻璃体内.于造模后6h、12 h、1d、2d、4d、5d、7d、14 d用裂隙灯及间接检眼镜观察眼部炎症情况并进行临床炎症评分.ELISA法测定各组造模后6h、12 h、1d、2d、4d、5d房水中TNF-α、IL-1β、CINC-1的含量变化.结果 造模后12 h、1d、2d、4d、5d、7d、14 d,Ⅱ组各时间点临床炎症评分分别为(2.50±0.55)分、(3.67±0.82)分、(4.00±0.63)分、(6.12±0.75)分、(7.00±0.63)分、(7.33±0.52)分、(5.50±0.54)分,Ⅲ组分别为(4.00 ±0.63)分、(6.17±0.75)分、(7.67±0.52)分、(10.60±0.82)分、(11.50±0.55)分、(11.80±0.41)分、(10.33±0.51)分,两组各时间点临床炎症评分间差异均有统计学意义(均为P＜0.05),造模12 h后Ⅲ组炎症反应明显较Ⅱ组重.Ⅱ组和Ⅲ组兔房水中TNF-α在炎症初期就开始升高,1d时达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中IL-1β含量于造模后1d时达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中CINC-1含量在造模后12 h时即达到高峰,与Ⅰ组相比差异均有统计学意义(均为P＜0.05).Ⅱ组和Ⅲ组兔房水中TNF-α、IL-1β、CINC-1各时间点相比差异均无统计学意义(均为P＞0.05).结论 外伤后机体的免疫调节机制在外伤性眼内炎发生发展过程中发挥重要作用,房水中TNF-α、IL-1β、CINC-1表达升高与炎症程度相关,调控细胞因子网络可能成为未来眼内炎一个有效的联合治疗措施.     

Delayed Sterile Endophthalmitis after Glaucoma Drainage Implantation

Glaucoma drainage devices are being used with increasing frequency for patients. Sterile endophthalmitis after implantation has been reported. Unlike traditional trabeculectomy surgery, the persistence of an implant may be contributory. As glaucoma specialists consider emerging technologies in implantable glaucoma drainage devices, it is important to understand that sterile endophthalmitis may be associated with these devices.     

Visual Recovery Following Mycobacterium chelonae Endophthalmitis

Following uncomplicated cataract surgery, a patient receiving etanercept for psoriatic arthritis developed Mycobacterium chelonae endophthalmitis. Vitrectomy, capsulectomy, and intraocular lens removal was followed by intravitreal amikacin, topical gatifloxacin, intravenous imipenem, and oral clarithromycin for six months. The patient achieved a final corrected visual acuity of 20/20. Etanercept has been implicated in the development of numerous, severe granulomatous infections, though not previously with M. chelonae. This represents the first reported case of visual recovery following M. chelonae endophthalmitis.     

Long-term immunosuppressive treatment of serpiginous choroiditis

Objective: To determine the efficacy of immunosuppressive treatment in serpiginous choroiditis. Design: The clinical courses were reviewed of six consecutive patients (12 eyes) with vision-threatening, steroid-dependent/resistant serpiginous choroiditis treated with a combination of immunosuppressive agents including azathioprine, cyclosporine, and cyclophosphamide. All patients underwent treatment for at least 12 months. Results: The follow-up period ranged from 17 to 105 months (mean 57, median 43). All patients were able to taper oral steroids. Five patients discontinued all immunosuppressive medications after a treatment period of 12 to 69 months (mean 39 months). Immunosuppressive treatment was continued in one patient at a ‘low’ maintenance dose. Ten eyes had improved visual acuities, while vision remained impaired in two due to macular scars. Recurrence was noted in two patients when an attempt was made to decrease the dose of immunosuppressive medication. Two patients experienced side effects which were reversed by decreasing the dose of the medications. Conclusion: Long-term immunosuppressive treatment appears to prolong remission and preserve vision in patients with serpiginous choroiditis.     

Chronic,Postoperative Pseudomonas luteola Endophthalmitis

An interventional case report is described of a patient with chronic postoperative endophthalmitis caused by the gram-negative aerobic rod Pseudomonas luteola. A 61-year-old developed slowly progressive blurring of vision, hypopyon, and vitritis following cataract surgery. Diagnostic vitrectomy and intraocular lens explantation were performed. The undiluted vitreous samples and explanted lens were analyzed. Aerobic cultures revealed moderate growth of P. luteola. The patient responded to intravitreal injections of piperacillin/tazobactam and oral trimethoprim/sulfamethoxasole. Best-corrected visual acuity improved from hand motions to 20/40. A repeat anterior chamber tap was negative. P. luteola may be a relatively nonvirulent cause of chronic endophthalmitis. Good visual outcomes may be obtained with appropriate therapy.     

Sympathetic Ophthalmia Following Vitrectomy for Endophthalmitis After Intravitreal Bevacizumab

Purpose: To describe a case of sympathetic ophthalmia following vitrectomy for endophthalmitis after an intravitreal injection of bevacizumab. Design: Retrospective case report. Methods: An 84-year-old male developed sympathetic ophthalmia 4 months after vitrectomy for endophthalmitis following an intravitreal injection. The inciting blind eye was enucleated. Results: Histopathology demonstrated sympathetic ophthalmia and phacoanaphylactic endophthalmitis. Visual acuity improved from 20/200 to 20/30 in the sympathizing eye with a combination of oral prednisone and azathioprine. Conclusions: Sympathetic ophthalmia can develop following exogenous endophthalmitis but has a good visual prognosis with appropriate treatment.     

Culture Proven Endogenous Bacterial Endophthalmitis in Apparently Healthy Individuals

Purpose: To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.

Design: Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.

Results: Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% ( 2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7?mmHg compared to 12?mmHg in the fellow eye). No eye was enucleated or eviscerated.

Conclusion: Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.