白内障摘除、人工晶状体植入术后眼内炎的临床分析

目的：探讨白内障摘除、人工晶状体植入术后眼内炎的易感因素、临床特点、治疗方法及效果。方法：回顾1997年6月至2001年8月，9例(9只眼)白内障摘除、人工晶状体植入术后眼内炎患者的易感因素、临床表现、治疗方法和结果，并作微生物学检查。结果：2例为糖尿病患者，2例患者有眼外伤史，l例为低蛋白血症患者。主要临床表现为眼红痛和视力障碍。9例患者中3只眼经抗生素、抗真菌药物治疗后，治愈；6只眼行玻璃体切除、晶状体后囊膜切除及人工晶状体取出术。5例患者保存了有用视力，4例眼球萎缩。微生物学检查：1例玻璃体培养发现D-型链球菌，3例房水涂片检查分别发现革兰氏阳性杆菌、革兰氏阴性杆菌和菌丝。结论：糖尿病、眼外伤、低蛋白血症可能是白内障摘除、人工晶状体植入术后眼内炎的易感因素。玻璃体手术、全身和局部抗生素或抗真菌药物的应用并联合使用糖皮质激素是治疗白内障摘除、人工晶状体植入术后眼内炎的有效手段。

Clinical analysis of endophthalmitis after cataract extraction and IOL implantation

Objective:To investigate the predisposing factors of endophthalmitis after cataract extraction and IOL implantation, clinical features, methods of treatment and therapeutic outcomes. Methods: Deta of 9 patients(9 eyes) with endophthalmitis after cataract extraction and IOL implantation in the 4-year period between June 1997 and Aug. 2001 were reviewed retrospectively and analysed in respect to the predisposing factors,clinical manifestations, therapeutic methods and outcomes,as well as microbiological examinations. Results:Of the 9 patients, 2 had diabetes, 2 had ocular trauma and 1 had hypoproteinemia. Clinical features were ocular redness,pain and lowering of vision. The 9 patients were treated with antibiotics or antifungal drags and corticosteroid orally and locally, and the endothalmitis in 3 patients cured,but failed in the other 6 patients,who had received vitrectomy,total capsulectomy with IOL explantation. 4 cases maintained useful eyesight,and four eyes suffered atrophy. Organism test showed D-streptobacillus in one patient's vitreous humor,and gram-positive bacterium,gram-negative bacterium and hypha were found separately in 3 patients' aqueous humor. Conclusion: The underlying diseases such as diabetes, hypoproteinemia or ocular trauma perhaps were predisposing factors for endophthalmitis after cataract extraction and IOL implantation. Vitrectomy together with antibiotics or antifungal and corticosteroid general and local application was effective in treating the endophthalmitis.