白内障术后眼内炎保留人工晶状体的治疗

目的 探讨在保留人工晶状体(IOL)情况下,玻璃体切除联合硅油填充手术治疗白内障术后眼内炎的疗效.方法 回顾性系列病例研究.收集2003至2008年因超声乳化自内障吸除联合IOL植入而发生术后眼内炎,在保留IOL的情况下接受玻璃体切除联合硅油填充术的7例患者(7只眼)的临床资料,观察其视力、裂隙灯显微镜、直接和间接眼底镜、眼压及眼部B超扫描结果 ,对手术疗效进行分析.采用配对t检验分析术前及术后眼压变化.结果 7例患者中男性5例,女性2例,年龄67.0～84.0岁,平均(70.0±4.5)岁.眼内炎发生时间平均为术后2 d(1～3 d).其中5只眼于术后3～6个月将硅油取出.术前视力无光感至手动.术前眼压平均为(35.0.±0.5)mm Hg(35.0～56.0 mm Hg,1 mm/Hg=0.133 kPa).平均随访(10±6)个月(6～43个月).术后视力无光感至0.8,视力提高6只眼(86%),不变1只眼(14%).眼压平均为(18.0±1.5)mm Hg(10.0～20.0mm Hg),显著低于术前眼压(t＝1.94,P＜0.05).并发症主要包括术后早期前房炎性渗出(7只眼),术后短暂高眼压(1只眼).无视网膜脱离和眼球萎缩.结论 在保留IOL情况下,玻璃体切除联合硅油填充手术对治疗超声乳化白内障吸除联合IOL植入术后眼内炎有一定疗效.

Treatment of postoperative endophthalmitis following cataract surgery without intraocular lens removal

Objective To explore the effects of vitrectomy combined with silicone oil injection on the treatment of postoperative endophthalmitis following cataract surgery without intraocular lens removal,and to analyze the relative factors.Methods This was a retrospective case serise study.Clinical data of 7 eyes of 7 patients with postoperative endophthalmitis following cataract surgery underwent the treatment of vitrectomy combined with silicone oil injection without intraocular lens removal from 2003 to 2008 were collected.The outcomes of vision,slit lamp examination, direct and indirect ophthalmoscopy,IOP,and B-scan were observed,and the snrgical effects were analyzed.Results Five patients were male, and 2 patients were female.The age ranged from 67.0 to 84.0 years with a mean of 70.0±4.5.The onset of endophthalmitis ranged from 1 to 3 days with a mean of 2 days.Silicone oil was removed in 5 eyes 3 to 6 months postoperatively.Preoperative visual acuity ranged from non light perception to hand moving.The mean preoperative intraocular pressure (IOP) was (35.0±0.5)mmHg with a range from 35.0 to 56.0 mmHg.Follow-up periods ranged from 6 to 43 months with a mean of (10±6) months.Postoperative visual acuity ranged from non light perception to 0.8.Postoperative vision increased in 6 eyes (865%),and was stable in 1 eye (14%).The mean postoperative IOP was (18.0±1.5) mmHg with a range from 10.0 to 20.0 mmHg,this was significantly lower than that preoperatively (t=1.94,p＜0.05).Postoperative complications mainly included fibrous exudates in the anterior chamber at early stage after the surgery (7 eyes) and temporary intraocular pressure elevation(1 eye).There was no retinal detachment and atrophia bulbi.Conclusion Vitrectomy combined with silicone oil iniection may be a safe and effective method in treating postoperative endophthalmitis following cataract surgery without intraocular lens removal.