Endogenous Endophthalmitis in the American and Korean Population: An 8-year Retrospective Study

Purpose: To study the clinical features of endogenous endophthalmitis (EE) in sample patient populations from the USA and South Korea over an 8-year period.

Methods: We reviewed data from 128 eyes of 60 American and 48 Korean patients diagnosed with EE and compared their clinical characteristics.

Results: Fungemia and liver abscess were the most common extraocular infection sources among American (26.7%) and Korean patients (33.3%), respectively. Klebsiella pneumoniae and Candida species were the most common pathogens of EE in the Korean and the American patients, respectively. Endophthalmitis caused by fungi had a better visual prognosis than that caused by bacteria (p = 0.001). Vitrectomy was beneficial for eyes with EE due to virulent bacteria presenting with worse than counting finger vision.

Conclusions: The predisposing conditions and responsible organisms for EE vary in different regions of the world. The visual prognosis was strongly influenced by the underlying pathogen.     

玻璃体腔注射曲安奈德后眼内炎诊断和治疗(附1例报告)

目的:报道眼内抗生素注药成功治愈玻璃体腔内注射曲安奈德后感染性眼内炎1例。方法:病例报道。结果:患者1例在接受玻璃体腔内注射曲安奈德后被培养证实并发感染性眼内炎,发病90多小时后进行了玻璃体腔内联合抗生素注射取得了满意的效果。结论:玻璃体腔内注射曲安奈德能够有效减轻视网膜分支静脉阻塞后的黄斑水肿,但患者应该被密切随访以警惕非感染性或细菌感染性眼内炎的发生。     

玻璃体切除联合玻璃体腔注药治疗外伤所致眼内炎

目的:探讨玻璃体切除联合玻璃体腔注射抗生素治疗外伤所致眼内炎的疗效。方法:对11例(11眼)外伤所致眼内炎进行玻璃体切除以及玻璃体腔注射抗生素,合并晶状体损伤、球内异物、视网膜裂孔及视网膜脱离的病例进行晶状体切除,球内异物取出,激光光凝及硅油或C3F8充填术。随访3mo～2a。结果:11眼(100%)控制了炎症,保留了眼球。6眼(55%)视力比术前提高,3眼(27%)视力无变化,2眼(18%)视力比术前下降。结论:玻璃体切除联合玻璃体腔注射抗生素能够有效治疗外伤所致眼内炎。     

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。     

Salmonella Typhi Associated Endogenous Endophthalmitis: A Case Report and a Review of Literature

Aim: To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature.

Methods: Retrospective chart review.

Results: A 28-year-old immunocompetent male presented with a 3-day-old history of pain, redness and diminished vision in his left eye. Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. Blood and vitreous cultures grew Gram negative bacilli, identified as S. typhi. Despite intensive intravitreal and systemic antibiotic therapy, an evisceration had to be performed.

Conclusions: Endogenous endophthalmitis can be one of the rare sequelae of enteric fever and may present in the acute and relapsing phases and often times have a rapidly fulminant course with poor visual outcomes.     

白内障术后眼内炎药物预防研究进展

白内障术后眼内炎是一种少见但破坏性极大的并发症。预防眼内炎的方式多种多样,其中术前应用聚维酮碘（povidone iodine,PVI）,术毕前房注射抗生素如万古霉素、头孢呋辛和氟喹诺酮类药物,以及围手术期局部抗生素应用是预防眼内炎的主要方式。本文就白内障术后眼内炎的流行病学、危险因素、致病因素及药物预防的研究进展作一综述。     

Raman spectroscopy for differential diagnosis of endophthalmitis and uveitis in rabbit iris in vitro

We developed a diagnostic tool to differentiate between endophthalmitis and uveitis using Raman spectroscopy. Twenty-two New Zealand rabbits with endophthalmitis induced by Staphylococcus aureus (10 animals), noninfectious uveitis induced by lipopolysaccharide from Escherichia coli (10 animals) and controls (two animals) were analyzed. Twenty-four hours after the eyes were inoculated, iris tissue was dissected and subjected to dispersive Raman spectroscopy using an excitation source at 830 nm and a spectrograph/CCD camera to detect a Raman signal with an integration time of 50 s. With the collected spectra of endophthalmitis and uveitis, we developed a routine to classify spectra in each specimen using principal components analysis, using a leave-one-out cross-validation procedure. The mean Raman spectra of tissues with uveitis and endophthalmitis showed several bands in the region of 800-1800 cm⁻¹, which have been attributed to nucleic acids, amino acids, proteins, and lipids. The bands at 1004, 1339, and 1555 cm⁻¹ differed significantly (t-test, p < 0.05) between diseases. The principal components PC3 and PC4 differed significantly (ANOVA, p < 0.05) for the two tissue types, indicating that these PCs can be used to discriminate between the two diseases using Mahalanobis distance as a discriminator. This technique is useful for differentiating the spectral bands of uveitis and endophthalmitis, and the diagnostic model showed sensitivity of 89%, specificity of 100%, and accuracy of 92% using the leave-one-out cross-validation procedure. These results may be clinically relevant for differentiating endophthalmitis from uveitis, and this approach may become a noninvasive method to optimize the diagnosis of inflammatory and infectious vitreoretinal diseases.     

头孢哌酮/舒巴坦玻璃体腔注射治疗兔铜绿假单胞菌性眼内炎

目的评价头孢哌酮/舒巴坦治疗铜绿假单胞菌眼内炎的疗效。方法青紫蓝兔18只,随机分为3组,右眼注菌后6h分别注入100g/L头孢哌酮/舒巴坦、22.5g/L头孢他啶和生理盐水各0.1mL,观察24h。另取青紫蓝兔12只,随机分为2组。早期注药组注菌后6h注入100g/L头孢哌酮/舒巴坦0.1mL,晚期注药组注菌后20h注入100g/L头孢哌酮/舒巴坦0.1mL,观察1周。结果头孢哌酮/舒巴坦组、头孢他啶组与生理盐水组比较除角膜评分外（P〉0.05）,结膜、前房、玻璃体、视网膜、B型超声检查及组织病理学评分结果差异均有统计学意义（P〈0.05）;头孢哌酮/舒巴坦组与头孢他啶组相比,除虹膜炎症反应评分差异有统计学意义外（P〈0.05）,其他评分差异均无统计学意义（P〉0.05）,但从具体评分来看头孢哌酮/舒巴坦组优于头孢他啶组。早期注药组与晚期注药组相比,1周后结膜、前房、虹膜、玻璃体、视网膜、B型超声检查及组织病理学评分差异均有统计学意义（P〈0.05）。结论 100g/L头孢哌酮/舒巴坦0.1mL玻璃体腔注射治疗早期铜绿假单胞菌眼内炎有效。     

外伤性眼内炎11例临床治疗分析

目的:探讨并分析外伤性眼内炎的治疗及临床疗效。方法:对9例外伤性眼内炎患者行玻璃体切除术,1例行眼球摘除术,1例儿童患者进行非手术治疗,并对疗效进行回顾性分析。结果:除眼球摘除患者外,治疗后10例患者视力均有所提高。结论:玻璃体切除术是治疗外伤性眼内炎的有效方法,对于症状较轻的儿童外伤性眼内炎可在严密观察下进行非手术治疗,但在经药物积极治疗24h后,视力不提高并且病情发展者,还应尽早行玻璃体手术治疗。     

外伤性眼内炎122例临床分析研究

目的 分析探讨外伤性眼内炎病原体的变化及治疗效果.方法 对2008年7月至2009年12月在我院就诊的122例126眼外伤性眼内炎的临床特点、外伤性质、病原体及治疗效果进行分析.结果 在外伤性眼内炎中,以细菌感染为主,真菌和混合性感染明显增加,玻璃体切除手术联合硅油注入及玻璃体腔注药后炎症得到控制,视力得到不同程度的提高,眼球摘除9眼.结论 外伤性眼内炎中真菌的比例明显增加,细菌的药物敏感性明显下降,玻璃体切除手术联合硅油填允及玻璃体腔注药术是治疗不同病原体引起的眼内炎的有效方法.