眼内异物伤眼内炎的临床观察

目的:探讨眼内异物伤眼内炎的感染因素、诊治情况.方法:收集256例眼内异物伤中42例发生眼内炎病例,从致病因素、微生物学检测及诊断治疗进行回顾性分析.结果:眼内异物伤眼内炎发生率为16.4%.眼后节异物及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素(P＜0.05).眼内异物伤Ⅰ期给予玻璃体腔注射盐酸去甲万古霉素及头孢他啶可以减少眼内炎的发生率(P<0.05).异物性质及大小、取出时间及伤口情况对眼内炎发生率无明显影响(P＞0.05).眼内异物伤眼内炎手术分级Ⅲ级最多.玻璃体切除手术是治疗眼内炎的主要手术方式.结论:眼后节异物伤及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素,Ⅰ期手术需处理白内障时尽量保留完整的晶状体后囊膜.建议眼后节异物伤Ⅰ期行玻璃体腔注射万古霉素及头孢他啶.一旦确诊眼内炎,尽早进行玻璃体切除手术.     

206例外伤性眼内炎病原菌分析及临床价值

目的了解外伤性眼内炎的病原菌分布,为临床选择有效的抗菌药物提供有价值的信息。方法对206例眼外伤患者采集前房液或玻璃体切割液进行病原菌培养和药物敏感试验并对结果进行分析。结果206例标本中有107例分离出病原菌,检出率为51.9%,革兰阳性球菌63株,占58.8%,革兰阳性杆菌11株（其中厌氧菌1株）,占10.3%,革兰阴性杆菌25株,占23.4%,真菌8株,占7.5%,致病菌中以革兰阳性球菌居首位,敏感率较高的为万古霉素、妥布霉素;革兰阴性杆菌其次,敏感率较高的是亚胺培南。结论有效治疗外伤性眼内炎有必要监测病原菌种类分布和药敏变化。目前,万古霉素、妥布霉素和亚胺培南是最有效的抗菌药物。     

Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post‐mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.     

Acute-on-chronic Liver Failure in a Patient with Candida Endophthalmitis: A Case Report

Acute-on-chronic liver failure (ACLF) is a risk factor for fungal infection. Endogenous fungal endophthalmitis is a serious, sight-threatening disease. Common causes include immunocompromised state and intravenous drug use, permitting opportunistic pathogens to reach the eye through the blood stream. We report a case of Candida endophthalmitis in a 47 year-old woman who was admitted to our hospital with ACLF and poorly controlled diabetes. In addition, she was treated with glucocorticoids due to severe jaundice. After treatment for ACLF, the patient experienced fever with blurred vision in the left eye and was diagnosed with candidemia, endogenous Candida endophthalmitis in the left eye, and chorioretinitis in the right eye. Systemic and topical antifungal treatment was administered based on the positive Candida albicans test in intraocular fluid using second-generation sequencing. The patient underwent vitrectomy in the left eye and C. albicans was confirmed in vitreous cultures. Follow-up visit, at 6 weeks after the operation, showed only light perception in the left eye and stable visual acuity in the right eye. Physicians should be aware of endogenous fungal endophthalmitis in patients with ACLF, especially those with Candida infection, a history of glucocorticoid use, and diabetes. A dilated retinal examination should be performed by an ophthalmologist if ACLF patients develop fever and fungal infection.     

Topical antibiotic prophylaxis for cataract surgery: a controlled trial of fusidic acid and chloramphenicol

The effectiveness of topical fusidic acid 1%, in a viscous drop base, to reduce or eliminate ocular microflora in patients undergoing cataract surgery has been studied. Forty-two patients received fusidic acid on a double-blind basis and for comparison 21 patients were similarly assessed with topical chloramphenicol. A further 17 patients received no treatment other than subconjunctival cephazolin administered to all operated eyes at the time of surgery. Quantitative bacterial counts from the conjunctivae and lash lines of each patient were made 24 hours before surgery, on the morning of operation and again 48 hours after surgery. With a regimen of five administrations on the day prior to surgery, neither topical fusidic acid 1.0% nor chloramphenicol 0.5% produced clinically or statistically significant reductions of the ocular microflora. In contrast perioperative subconjunctival cephazolin effectively reduced or eliminated lid and conjunctival microflora following surgery. This study indicates that the effectiveness of a topical antibiotic preparation for overt ocular infection cannot be directly extrapolated to the effect on resident ocular microflora, at least with short-term use for presurgical prophylaxis.     

青光眼薄壁滤过泡相关性眼部感染临床分析

目的:分析和探讨青光眼滤过术后薄壁滤过泡相关性眼部感染发生的危险因素,临床特点,处理和防治方法。方法:回顾性分析2002-06/2007-12我科收治的由于薄壁滤过泡产生相关并发症的患者的临床资料。结果:共收集10例青光眼滤过手术后薄壁滤过泡感染患者的资料。其中,单纯滤过泡感染7例,滤过泡伴眼内炎3例。感染发生于术后1～24mo不等。所有患者均使用过丝裂霉素(MMC),病原学培养阳性率为50%,以革兰氏阳性球菌为主。感染病例经药物治疗,感染控制良好。所有病例均予手术治疗,术后滤过泡薄壁状况改善,视力提高,眼压控制良好。结论:薄壁滤过泡与滤过泡感染及迟发性滤过泡相关性眼内炎的发生密切相关,MMC的使用是导致薄壁滤过泡的重要原因。药物和手术治疗可以消除炎症,维持正常眼压,改善视力。     

Endogenous filamentous fungal endophthalmitis--single-centre survey in patients with acute leukaemia or postallogeneic stem cell transplantation and review of the literature

Endogenous endophthalmitis caused by filamentous fungi has been infrequently described and its prognosis in immunocompromised patients is largely unknown. Patients were identified through a single-centre database containing patients with endophthalmitis. Cases published since 2002 were reviewed. Clinical and treatment features as well as outcomes were analysed. Six patients were identified from the database. Underlying conditions were haematological malignancies (HM) and/or allogeneic haematopoietic stem cell transplantation (HSCT). Three patients underwent vitrectomy. None of the patients survived and the median time from first evidence of endophthalmitis until death was 33 days. The median time from first evidence of an invasive fungal infection to endophthalmitis was only 5 days. Fifty-six patients were identified from the literature. The majority of these patients underwent vitrectomy (27) or enucleation (10) and received intraocular antifungal therapy (28). Only 13 (23%) of 56 patients experienced an improved vision. The survival rate was 52% in all 56 patients but was significantly less in patients with HM or post-HSCT when compared with all others (26% vs. 70%, respectively; P = 0.003). Endogenous endophthalmitis caused by filamentous fungi is frequently associated with a permanent decrease or loss of vision. This type of fungal infection carries a particular poor prognosis in patients with profound immunosuppression, requiring improved treatment strategies.     

Determination of drug concentration in aqueous humor of cataract patients administered gatifloxacin ophthalmic gel

Background Ophthalmic gel has been developed to increase the drug concentration in aqueous humor and to retard the loss of drug from the conjunctival sac.The research was to compare the drug concentration in aqueous humor of cataract patients administered 0.3% gatifloxacin ophthalmic gel with that in patients administered 0.3% gatifloxacin ophthalmic solution.Methods Ninety-six patients with cataract （96 eyes） were randomly assigned to 8 groups.The patients in groups 1-4received topical gatifloxacin 0.3% ophthalmic gel and those in groups 5-8 received gatifloxacin 0.3% ophthalmic solution.The dose regimen was 1 drop, 4 times a day for 3 consecutive days prior to cataract surgery.On the day of surgery, 1drop was applied at 15, 30, 60 or 120 minutes before commencement of cataract surgery in groups 1 and 5, groups 2 and 6, goups 3 and 7, and groups 4 and 8, respectively.Aqueous humor was extracted during the cataract surgery for the analysis of gatifloxacin concentration..Results The concentrations of gatifloxacin in aqueous humor were （0.24±0.25） μg/ml, （1.11±0.74） μg/ml, （2.32±2.01）μg/ml and （1.85±1.14） μg/ml in groups 1 to 4, and （0.16±0.25） μg/ml, （0.31±0.24） μg/ml, （0.75±0.28） μg/ml and （0.33±0.22） μg/ml in groups 5 to 8, respectively.Patients receiving gatifloxacin ophthalmic gel showed greater mean values of gatifloxacin concentration in aqueous humor than those receiving gatifloxacin solution, and such differences were significant with P 〈0.05 for all comparisons except that between groups 1 and 5.Conclusion Topical gatifloxacin ophthalmic gel can attain significantly greater drug concentrations in human aqueous humor than gatifloxacin ophthalmic solution.     

做好围手术期准备降低内眼手术后感染的风险

目的 讨论眼内手术和玻璃体腔注射术后发生细菌性眼内炎的危险因素和围手术期规范化管理.方法 针对易引起眼内手术和玻璃体腔注射术后感染的因素进行分析,规范了眼内手术和玻璃体腔注射标准、建立健全严格的消毒、器械清洗制度,严格管理无菌植入物品使用,强化医护人员的无菌观念.结果 通过完善围手术期感染控制流程,提高医护人员预防手术感染意识,确保手术的安全,降低了眼内手术感染率.本组眼内手术和玻璃体腔注射4096例,细菌性眼内炎3例,眼内炎的发病率为0.07％.结论 做好围手术期准备,规范眼内手术和玻璃体腔注射标准和严格的无菌操作是减少术后细菌性眼内炎的重要措施.