内源性眼内炎病因和临床治疗13例分析

目的分析内源性眼内炎的病因、全身易感因素及治疗结果。方法回顾13例（14眼）内源性眼内炎患者发病时的全身状况及眼部情况,玻璃体液的涂片和培养结果,治疗方法和视力愈后。结果13例（14眼）内源性眼内炎均行玻璃体液涂片和培养,阳性9例（10眼）,其中细菌6例（7眼）,包括革兰阳性球菌2例（2眼）、大肠埃希菌1例（1眼）、结核杆菌1例（1眼）、绿脓杆菌2例（3眼）;真菌3例（3眼）。11例患者有全身易感因素。在药物治疗的同时,除2眼行眼内容摘出外,其余均行玻璃体切割术,7眼保住眼球并有数指或以上视力,其中2眼最终视力〉0.05。结论内源性眼内炎的病因为全身感染性病灶或败血症的微生物感染所致,包括细菌和真菌感染,处理棘手,及时行玻璃体切割术,有助于改善患者的视力愈后。     

壳聚糖药膜植入脉络膜上腔治疗兔眼细菌性眼内炎

目的比较玻璃体腔注射万古霉素联合脉络膜上腔植入载有曲安奈德(triamci-nolone,TA)的壳聚糖膜与其玻璃体腔注射TA对兔外源性金黄色葡萄球菌的治疗作用。方法30只健康青紫蓝兔均于右眼内注射ATCC25923标准金黄色葡萄菌0.1×109CFU.L-1混悬液0.1mL。建立眼内炎模型后24h,将实验动物随机分为3组,均对右眼进行干预,每组10眼,A组玻璃体腔注射万古霉素、B组玻璃体腔注射万古霉素 TA混悬剂、C组玻璃体腔注射万古霉素 脉络膜上腔植入壳聚糖缓释药膜(载TA)。干预后每日裂隙灯及间接眼底镜观察;注射细菌后24h及干预后14d行B超检查;干预5d行玻璃体腔细菌培养;干预后14d摘除所有术眼于光镜下观察组织病理学改变。结果C组较A、B组炎症明显减轻。不同时间3组进行临床炎症评分,C组各项评分明显低于其他2个对照组,治疗后不同时间A、B、C3组总的炎症评分有显著性差异均为P=0.000,组间对比C组与A、B2组均有显著性差异P=0.000,A、B2组间无显著性差异(P<0.05)。细菌学培养检出率无统计学意义P=0.830;B超显示A、B、C3组视网膜脱离发生率有显著性差异(P=0.015);光镜下见C组眼部各组织结构完整,角膜、前房、玻璃体、视网膜病理学评分A、B、C3组间有显著性差异(P均为0.000),组间比较除A、B2组间视网膜评分有显著性差异(P=0.011),其余各组间各项病理评分均无显著性差异。结论壳聚糖药膜植入脉络膜上腔安全有效,可以成为治疗细菌性眼内炎的一种新的治疗方法。     

玻璃体切割术治疗外伤性眼内炎

目的:评价玻璃体切割联合眼内药物灌注治疗严重的外伤性眼内炎的临床效果.方法:回顾性分析30例(30眼)因外伤性眼内炎行玻璃体切除术,术中联合药物玻璃体腔灌注的患者.结果:术后 3mo 29 眼炎症得到控制,眼球得以保留,28眼视力有不同程度提高.眼内异物是最常见的受伤原因,金黄色葡萄球菌是最常见的细菌.结论:及时行玻璃体切割术联合眼内药物灌注是治疗外伤性眼内炎的有效方法.     

Pyogenic liver abscess complicated by endogenous endophthalmitis

Background: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. Methods: Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. Results: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. Conclusion: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.     

Topical anaesthesia: a risk factor for post‐cataract‐extraction endophthalmitis?

Purpose: To investigate if the incidence of postoperative endophthalmitis in temporal clear corneal cataract surgery is influenced by the use of topical anaesthesia compared to retrobulbar anaesthesia. Methods: A retrospective study was conducted of one surgeon's cataract surgery between October 1997 and October 2001. Results: Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retro­bulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2‐tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low‐grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis. Conclusion: Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.     

超声乳化白内障摘除术后眼内炎的临床探讨

目的:探讨超声乳化白内障摘除术后眼内炎的发生,预防和治疗方法。方法:对2001/2007间行超声乳化白内障摘除人工晶状体植入术的15615眼进行回顾性分析。结果:全部术眼中有9例术后发生眼内炎。均于发现后立即行玻璃体切割玻璃体注药术,并做玻璃体细菌学检查,3眼细菌培养阳性,1眼证实为真菌感染。2眼治疗后无光感,1眼眼球摘除。结论:超声乳化摘除术后眼内炎的发生率为0.058%,危险因素主要为结膜囊的污染和后囊膜破裂。术前严格消毒,减少后囊膜破裂的发生,同时积极地治疗可控制其发生和发展。     

Endophthalmitis following cataract surgery in Southwest Finland from 1987 to 2000

Purpose To investigate the incidence, causes, prevention, treatment and outcome of postoperative endophthalmitis (POE) following cataract surgery in south-west Finland from 1987 to 2000. Methods We reviewed the medical records of all patients with POE following cataract surgery treated in the hospital district of Southwest Finland from 1 January 1987 to 31 December 2000. Population-based annual incidence rates of cataract extractions and POE were calculated using the corrected population statistics of the hospital district. Results There were 29,350 cataract procedures during the 14-year period. POE developed in 47 patients. The annual incidence of cataract operations increased more than fivefold from 1987 (155 per 100,000 population) to the maximum in 1999 (930 per 100,000 population), whereas the annual incidence of postcataract endophthalmitis decreased from the maximum of 11.1 per 1,000 cataract extractions (1.91 per 100,000 population) in 1988 to the minimum of 0–0.6 per 1,000 cataract extractions in 1999 and 2000. POE occurred statistically significantly more frequently after extracapsular cataract extraction (ECCE) than after phacoemulsification (Phaco) (P=0.0006). Gram-positive bacteria were the most frequent cause of acute POE and Propionibacterium acnes was the most frequent reason for delayed-onset POE. The complications of POE after cataract surgery included visual loss to below 0.05 (25.5% of affected eyes), opacification of the cornea (21.3%), secondary cataract (40.4%), increase in intraocular pressure (29.8%), vitreous clouding (63.8%), and retinal detachment (6.4%). Nearly one half of the eyes achieved final visual acuity of 0.5 or better. Conclusions During the 14-year study period there was a shift from ECCE to Phaco, a fivefold increase in cataract extractions, and a decrease in the annual incidence of POE from 5.5–11.1 to 0–0.6 per 1,000 operations. Phaco was associated with a lower risk of POE than ECCE. None of the authors has a financial or proprietary interest in any material or method mentioned.     

Enucleation versus evisceration

The choice of enucleation and evisceration for removal of an eye remains controversial in certain circumstances. An international panel was asked to give their surgical management of two clinical cases that require either enucleation or evisceration. Case one follows multiple vitreoretinal procedures, and the risk of sympathetic ophthalmia is considered in the surgical management. Case two has had postoperative endophthalmitis, and the possibility of implant infection following insertion of an orbital implant with evisceration and enucleation is discussed.     

Silicone oil in the surgical treatment of endophthalmitis associated with retinal detachment

Purpose: To investigate the useof silicone oil in thepatients who had undergone vitrectomy for the treatment of endophthalmitis associated with retinal detachment.Methods: Six consecutive cases of endophthalmitis associated with retinal detachment were included in the study. The mean age of the 4 males and 2 females was 47.25 ± 23.76 years. Endophthalmitis associated with retinal detachment occurred following perforating injuries in 4 eyes, pneumatic retinopexy in 1 eye and cataract surgery complicated with vitreous loss in 1 eye. Preoperative visual acuity was light perception-only in all eyes. Red reflex was absent in all eyes. All the patients underwent vitreous tapping,encirclement, vitrectomy ,liquid-gasexchange, endolaser photocoagulation and silicone oil injection. Results: Mean follow-up time was 14.3 ± 7.20 months. The microorganisms that were isolated from the vitreous aspiration were Staphylococcus epidermidis in 3 cases, Staphylococcus aureus in 1 case. Remaining cases were culture negative. Retinal breaks could be found in 4 eyes. Inflammation subsided significantly at 5 days in all cases. Final retinal reattachment and treatment of endophthalmitis was achieved in 5 eyes at the end of follow-up . Final visual acuity was 20/40 in 1 case, counting finger in 4 cases and no light perception in 1 case. The postoperative complications were optic atrophy in 1 eye, epiretinal membrane in 2 eyes and phitisis bulbi in 1 eye.Conclusion: Silicone oil, a retinal tamponading agent that has antimicrobial activity, may have benefical effect in the surgical treatment of endophthalmitis associated with retinal detachment.