重症化脓性眼内炎分次玻璃体手术治疗探讨

目的探讨重症化脓性眼内炎分次玻璃体视网膜手术的临床疗效。方法对21例(21眼)重症化脓性眼内炎急诊行第1次晶状体及玻璃体切除手术,术中抽吸少许房水及玻璃体进行细菌培养和药敏试验,将眼内大部分脓液清除,有异物者摘出异物,术毕眼内注入适量抗生素,经药物治疗7～14d角膜透明或基本透明后行第2次的玻璃体手术,复位脱离的视网膜、激光封闭裂孔及眼内充填。结果第1次玻璃体手术后,眼内炎症均得到控制,约6～7d后角膜逐渐恢复透明,13眼发生视网膜脱离,第2次玻璃体视网膜手术后视网膜均达到解剖复位。随访3～24月,视网膜解剖在位17眼,眼球萎缩4眼。最终矫正视力≥0.02者13眼。结论重症化脓性眼内炎分次行玻璃体视网膜手术,结合合理的药物应用是较好的治疗方法。

Two-step vitreoretinal surgery for severe suppurative endophthalmitis

Objective To investigate the clinical effect of two-step vitreoretinal surgery for severe suppurative endophthalmitis.Methods 21 patients(21 eyes) with severe suppurative endophthalmitis performed with two-step vitreoretinal surgery.firstly,emergency lensectomy and vitrectomy were performed,and aquesous humor and vitreous was aspirated for bacterial culture,and foreign bodies were taken out if they were found.Proper amount of antibiotics was injected into the eye at the end of the surgery.After 7-14 days of medication,cornea recovered transparency completely or mostly,then vitrectomy was performed for the second time.The detached retina was reattached,retinal tears were photo-coagulated and inert gas or silicone oil was filled into the eye in the surgery.Results Endophthalmitis was controlled after the vitreous surgery for the first time.The transparence of the cornea gradually recovered completely after 6-7 days.Retinal detachment occurred in 13 eyes.The retina was anatomically attached after the vitreous surgery for the second time.4eyes occurred atrophy after 3-24 months follow-up.Best corrected visual acuity 0.02 or better was presented in 13 eyes.Conclusions Two-step vitreoretinal surgery combined proper medication is reasonable treatment for severe suppurative endophthalmitis.