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1.
刘铁  解成志  谢同朴 《国际眼科杂志》2019,19(10):1764-1767

目的:探究年龄相关性白内障手术后发生感染性眼内炎的病原学特点及相关因素与预防。

方法:回顾性分析本院2016-01/2018-01收治的1 365例年龄相关性白内障患者,统计患者感染性眼内炎发生情况,并分析感染性眼内炎病原学特点及相关危险因素。

结果:患者28例发生感染性眼内炎,共检出病原菌36株,其中表皮葡萄球菌9株(25.00%),铜绿假单胞菌9株(25.00%),芽孢杆菌8株(22.22%)。铜绿假单胞菌、芽孢杆菌对头孢唑林、头孢噻肟、阿莫西林具有较强的耐药性; 对头孢哌酮-舒巴坦、美罗培南的敏感性较高; 表皮葡萄球菌对青霉素、红霉素、阿奇霉素有较强的耐药性,对万古霉素、呋喃妥因、米诺环素的敏感性较高。Logistic多因素回归分析,年龄(≥70岁)、糖尿病、手术时间(≥15min)、术中玻璃体溢出是年龄相关性白内障术后发生感染性眼内炎的独立危险因素(P<0.05)。

结论:年龄相关性白内障手术后感染性眼内炎病原菌以表皮葡萄球菌、铜绿假单胞菌、芽孢杆菌多见。年龄(≥70岁)、糖尿病、手术时间(≥15min)、术中玻璃体溢出为年龄相关性白内障手术后发生感染性眼内炎的独立危险因素。  相似文献   

2.
Purpose: To illustrate the rate of endogenous endophthalmitis associated with fungemia and evaluate the importance of screening in a public city hospital.

Methods: A retrospective review was performed on all inpatient ophthalmology consults for fungemia from 2010 to 2015. Clinical histories, ocular examinations, and microbial cultures were reviewed.

Results: Of 95 patients (mean age 51.6 years, 75% male) with fungemia, 9/95 (9.5%) demonstrated intraocular involvement. Of these nine patients, two were unable to participate in the ophthalmic exam due to intubation, while the remaining seven reported no changes in their vision. Two patients had their antifungal medications adjusted to optimize intraocular penetration and one patient progressed to develop vitreous involvement but died before further escalation of care occurred.

Conclusion: All involved individuals in this study were either non-communicative or without visual complaints. This suggests that routine screening should still be recommended, especially in a public hospital setting.  相似文献   

3.
Abstract

Purpose: To compare the incidence of pseudophakic cystoid macular oedema (CME) in patients who receive intracameral cephalosporin versus intracameral vancomycin during cataract surgery.

Methods: A retrospective chart review was conducted on subjects with the diagnosis of CME between January 1 2010 and July 31 2017. Inclusion criterion was the documentation of CME after cataract extraction. Exclusion criteria were intraoperative complication, prior history of macular oedema, epiretinal membrane, uveitis, other pre-existing retinal pathology, or other post-operative pathology including other ocular surgery in the post-operative period.

Results: The final analysis included 89 eyes with optical coherence tomography (OCT) proven CME. The incidence of pseudophakic CME in our population of 10,165 cataract surgeries after applying the above-stated exclusion criteria was 0.88%. The incidence of pseudophakic CME in subjects who received intracameral cephalosporin was 0.87% (mean age in years 69?±?11; 31 male [39%], 48 female [61%]). The incidence of pseudophakic CME in subjects who received intracameral vancomycin was 0.96% (mean age in years 66?±?13; 4 male [40%], 6 female [60%]). Pearson’s chi-square test demonstrated no significant difference between these groups (p?=?0.7705).

Conclusions: There was no statistical difference in the incidence of pseudophakic CME in subjects who received intracameral cephalosporin versus intracameral vancomycin during cataract surgery.  相似文献   
4.
ABSTRACT

Purpose: To report a case of Candida albicans endogenous endophthalmitis in an immunocompetent patient with onychomycosis.

Methods: Retrospective case report.

Results: A 40-year-old man with onychomycosis presented with C. albicans subretinal abscess in the left eye. Systemic and intravitreal injections did not prevent further progression of the infection. The patient underwent pars plana vitrectomy. One month after surgery, the intraocular inflammation gradually subsided. However, his visual acuity stayed at counting fingers as a result of macular scarring.

Conclusion: The aim of this case presentation is to emphasize that endogenous fungal endophthalmitis can be seen in an immunocompetent patient. The use of systemic steroids in the past was the main reason for the progression of the disease in this case. In these situations, when the clinical findings suggest a fungal etiology, it should keep in mind that endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails and systemic steroids should not be started before definite diagnosis.  相似文献   
5.
Streptococcus pyogenes is a rare pathogen that causes endogenous endophthalmitis (EE). A healthy 58-year-old woman was diagnosed with EE secondary to septic arthritis caused by S. pyogenes. She underwent enucleation after hospitalization for 14 days with appropriate antibiotic cover. A literature search for outcomes of this condition revealed reports on only 10 eyes among 8 cases identified: 8 eyes (80%) developed poor visual outcome and 5 eyes (50%) underwent enucleation. There were no cases with immunocompromise. Our case report and literature review suggest the importance of awareness of the occurrence of S. pyogenes infection in immunocompetent hosts, and thus early diagnosis and aggressive treatment may be required to improve visual outcome.  相似文献   
6.
Purpose:To evaluate the clinico-microbiological profile, donor cornea risk factors, and outcomes of postkeratoplasty endophthalmitis at a tertiary care center.Methods:Retrospective analysis of charts of 28 consecutive patients (28 eyes) of acute endophthalmitis following either an endothelial keratoplasty (EK) or an optical penetrating keratoplasty (PK) surgery, performed between 2006 and 2018 (13-year period). Positive microbiology, identification and classification of predisposing factors, surveillance of utilized paired donors, treatment outcomes, and differences in the rate and severity of the event between optical penetrating and endothelial keratoplasty.Results:The estimated incidence of endophthalmitis was 0.23% in the entire cohort; it was 0.34% and 0.15%, after EK and PK, respectively (P = 0.049). The median time of endophthalmitis was 4.5 days postsurgery. Donor-related endophthalmitis was recognized in 7/28 (25%) eyes. Culture positivity was 68% (n = 19 of 28). Bacteria was isolated in 84% (n = 16 of 19) instances; Gram-negative bacilli were more common (87.5%; 14 of 16), and Pseudomonas species (50%; 7 of 14) was the most common Gram-negative bacterium. Majority (>75%) of the Gram-negative bacteria were resistant to all fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, and meropenam; 1/3rd were resistant to imipenem; and 90% were sensitive to colistin. Treatment included intraocular antibiotic injections (96.4%), vitrectomy (42.9%), and therapeutic keratoplasty (50%). In 85.7% (24 of 28), globe was salvaged. The final vision was 20/200 or better in 39.1% (9 of 23) eyes.Conclusion:EK carried a higher risk of endophthalmitis than PK in this cohort. Bacterial infection was more common in this series, with Gram negative bacilli being the commonest organisms. Multidrug resistance was common (~75%) in Gram negative isolates.  相似文献   
7.
目的:分析白内障手术灌注液中庆大霉素对白内障患者结膜囊细菌的作用,为制定围手术期眼内炎预防措施提供依据。方法:采集200例白内障患者结膜囊拭子标本,进行细菌培养鉴定和药物敏感试验,观察检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率。结果:结膜囊细菌培养阳性检出率为62%,其中以表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为3.22%,耐甲氧西林表皮葡萄球菌(MRSE)检出率为28.2%;全部检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为79.84%、95.16%、97.58%、78.23%,中高浓度庆大霉素和左氧氟沙星比较,差异有统计学意义(均P<0.05);MRSA和MRSE对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为69.23%、94.87%、100%、41.03%,各浓度庆大霉素和左氧氟沙星比较,差异有统计学意义(均P<0.05)。结论:白内障患者结膜囊细菌对灌注液中庆大霉素具有较高的敏感度,灌注液中加入适宜浓度庆大霉素,作为白内障围手术期眼内炎预防的措施应继续加以推广。  相似文献   
8.
眼内炎在玻璃体切除术后的发生率极低,在硅油眼中更为罕见。硅油对微生物的细胞膜有毒性作用,并可以导致其缺乏营养,被认为可抑制细菌和真菌的生长。硅油眼术后混合性眼内炎,特别是革兰阴性菌的感染报道较少。通过回顾1例由病原菌检测诊断证实的硅油眼中混合感染摩氏摩根菌和表皮葡萄球菌眼内炎患者的临床表现和诊疗经过,提高对混合性感染的认识和诊断水平。  相似文献   
9.
近年来,由于手术方式、仪器设备和人工晶状体的改进,白内障术后并发症的发生率已明显下降。晶状体上皮细胞间质转化机制学说和人工晶状体材料及设计研究有了新的突破,为后发性白内障的防治提供了新途径。大量临床研究证实,术毕前房注射抗生素(头孢呋辛或莫西沙星)可显著降低术后眼内炎的发生率,包括术中合并晶状体后囊膜破裂的患者,未来有望在临床广泛推广。体外培养人角膜内皮细胞和促角膜内皮细胞增生药物的研发为白内障术后角膜内皮损伤的治疗带来了曙光。利用光学相干断层扫描、光学相干断层扫描血管成像能在早期准确诊断白内障术后黄斑囊样水肿,且非甾体抗炎药或抗血管内皮生长因子药物玻璃体内注射对此疗效明确。随着研究的深入,进一步认识到先天性白内障手术时机、人工晶状体植入否与术后继发性青光眼的相关性。高度近视眼患者晶状体屈光性手术的提前,增加了这类患者晚期人工晶状体-囊袋复合体脱位的发生率,并让相应治疗面临新的挑战。飞秒激光辅助的白内障手术因其精准性和安全性已在临床逐渐应用,但仍需关注其可能带来的干眼、瞳孔缩小、视网膜光损伤等并发症。另外,由于糖尿病的高发病率,对糖尿病患者的白内障手术应全面、综合、系统地治疗,以防止术后各种眼表、眼底并发症的发生。本文就上述各方面的研究现状和相应对策进行综述,以期帮助眼科医生进行临床诊疗。  相似文献   
10.

目的:比较白内障术前应用不同浓度聚维酮碘(PI)在结膜囊作用不同时间,观察PI的消毒效果,以及对结膜囊菌群、眼表的影响,筛选PI的最佳浓度和作用时间。

方法:本研究为前瞻性研究,选择2015-06/2017-06于我院行白内障手术患者270例270眼,根据用药浓度(5、1、0.5g/L)随机分为三组,每组90眼。根据不同作用时间(30s,1、2min)进一步随机分配各个亚组,每亚组各30眼。患者按分组情况进行术前PI结膜囊冲洗,并于冲洗前后进行结膜囊细菌样本采集,比较PI冲洗前后结膜囊细菌菌群变化和细菌培养阳性情况。同时比较术前3d与术后1、3d,1wk,1、3mo的泪膜破裂时间(BUT)、角膜荧光素染色(CFS)变化,观察PI冲洗结膜囊对眼表的影响。

结果:(1)结膜囊菌群变化:PI冲洗前结膜囊细菌培养共12种,其中革兰氏阳性菌9种,革兰氏阴性菌3种; PI冲洗后结膜囊细菌培养共4种,其中革兰氏阳性菌2种,革兰氏阴性菌2种。(2)结膜囊细菌培养阳性情况的比较:PI冲洗前结膜囊细菌培养阳性15眼,冲洗后细菌培养阳性5眼,PI冲洗前后细菌培养阳性眼数减少(P<0.05)。(3)安全性:所有患者术后末次随访,术眼均未发生眼内炎,除0.5g/L、30s组及5g/L、2min组外的所有组别,BUT均在术后3mo恢复术前水平。0.5g/L、30s组BUT术后1mo就恢复到术前水平,5g/L、2min组BUT至术后3mo仍未恢复至术前; 所有组别CFS均在术后1mo恢复至术前水平。

结论:0.5g/L PI结膜囊冲洗30s能有效减少结膜囊细菌,较其他作用时间和浓度组对眼表的损伤更小,用于白内障术前结膜囊消毒是安全有效的。  相似文献   

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