感染性眼内炎临床特征及危险因素分析北大核心CSCD

目的分析感染性眼内炎患者致病原因、病原学培养结果、治疗情况及危险因素。方法回顾性分析参与研究患者的临床资料,采集患者眼内液标本进行病原微生物培养与鉴定,根据患者眼内炎严重程度采用不同治疗方法进行治疗,采用二元logistic回归分析白内障患者术后发生感染性眼内炎的危险因素。结果72例感染性眼内炎患者中,主要为外源性眼内炎(65例)。37例有眼部手术史,主要为白内障术后(28例),28例有外伤史,主要为穿通伤(18例)。72份眼内液标本中,28份标本培养结果阳性。病原菌以表皮葡萄球菌(9株)为主。外源性眼内炎患者与内源性眼内炎患者分泌物标本培养阳性率具有统计学意义(P<0.05)。72例感染性眼内炎患者,13.89%行前房或玻璃体注射抗菌药物及全身药物治疗,83.33%接受玻璃体切除手术,2.78%经药物及手术治疗无果行眼内容剜除术或眼球摘除术(均为内源性眼内炎)。经过治疗,眼球保留率为97.22%。患者治疗前后最佳矫正视力结果,60例术前最佳矫正视力低于0.02,45例术后最佳矫正视力低于0.02,两者对比差异有统计学意义(P<0.05)。感染组与对照组对比分析显示,年龄、合并糖尿病、手术时间、术中玻璃体溢出对比差异具有统计学意义,二元logistic回归分析显示,患者白内障手术时间>30 min、术中玻璃体溢出为白内障患者术后发生感染性眼内炎的独立危险因素。结论感染性眼内炎患者主要为外源性眼内炎,其中白内障术后眼内炎患者占比最高。患者进行白内障手术时间长、术中玻璃体溢出容易引发术后感染性眼内炎。     

非玻璃体切割手术治疗白内障术后细菌性眼内炎的体会

目的探讨白内障术后细菌性眼内炎采用前房冲洗及药物途径的体会。方法眼内炎患者6例(6只眼)均采取前房冲洗,2例患者行球周注射万古霉素,4例患者行球内注射抗生素(其中3例注射万古霉素和头孢他啶)。观察治疗后眼内炎的控制情况、手术前后视力及并发症。结果术后随访3~6个月,6例患者经前房冲洗、局部应用抗生素后,眼内感染性炎症均得到控制。4例患者治疗后视力较治疗前明显提高。2例患者随诊期间出现视网膜脱离。结论白内障术后细菌性眼内炎的预后取决于有效抗生素介入的时间。在没有病原学支持的情况下,尽早采用前房冲洗联合广谱抗生素玻璃体腔注射能够有效地控制细菌性眼内炎。如果出现玻璃体及视网膜等并发症还应尽早行玻璃体切割手术治疗。     

超声乳化术治疗白内障后感染性眼内炎病原菌分布及影响因素研究

目的观察超声乳化术治疗白内障后感染性眼内炎病原的分布情况,总结相关危险因素,为临床合理用药及降低术后感染提供合理依据。方法选取2014年8月~2018年7月在本院行超声乳化术治疗的12 100例(眼)白内障患者为观察对象,对其临床资料予以回顾式分析,总结术后感染性眼内炎患者的病原菌分布情况,分析耐药性以及引发感染的相关影响因素,采用SPSS20.0进行统计分析。结果 12 100例(眼)患者均顺利完成超声乳化术治疗,术后发生感染性眼内炎38例,发生率0.31%,共检出病原菌25株,其中23株革兰阳性菌,占92.00%,主要以腐生葡萄球菌、头状葡萄球菌以及表皮葡萄球菌为主,白色假丝酵母菌2株,占8.00%;革兰阳性菌对常规药利福平、万古霉素以及利奈唑胺的耐药率均为0。术后发生感染性眼内炎的主要危险因素包括手术时间较长、年龄、玻璃体溢出、行透明角膜切口手术以及并发糖尿病且差异均有统计学意义(OR值分别为1.497、1.432、1.693、1.568,P0.05)。结论行超声乳化术治疗白内障后感染性眼内炎患者主要以革兰阳性菌为主,真菌较少,革兰阳性菌对利福平、万古霉素以及利奈唑胺的敏感性较高,术后感染影响因素较多,要给予相应措施进行干预。     

白内障合并糖尿病患者在超声乳化吸除术后发生感染性眼内炎的危险因素分析

目的探讨超声乳化白内障吸除术后糖尿病患者发生感染性眼内炎的危险因素分析。方法研究选择2010年12月—2015年12月,在该院眼科行超声乳化白内障吸除术的800例白内障合并糖尿病患者,对其进行回顾分析,分析术后感染性眼内炎患者的病菌分布情况以及出现感染性眼内炎的相关危险因素等。结果 800例行超声乳化白内障吸除术的患者术后共16例患者出现感染性眼内炎,发生率为2.00%,经过检测后,检出病原菌共16株,其中格兰阳性菌共14株,占87.50%,其中主要包括表皮葡萄球菌、头状葡萄球菌、腐生葡萄球菌以及粪肠球菌,而真菌共2株,占12.50%;手术切口、手术时间、玻璃体溢出以及合并高血压等因素和患者术后发生感染性眼内炎有着显著的相关性(P0.05)。结论白内障合并糖尿病患者行超声超声乳化吸除术后出现感染性眼内炎的病原菌以格兰阳性菌为主,且受多种因素的影响,需要采用相应的措施来降低感染性眼内炎的发生率。     

玻璃体切除治疗感染性眼内炎

玻璃体切除治疗感染性眼内炎青岛医学院附属医院（２６６００３）仇宜解眼内炎是由于内眼手术或穿通性眼外伤后，致病菌侵入眼内造成感染，从而引起的玻璃体、视网膜、脉络膜等眼内组织的化脓性炎症。因眼球对致病菌的抵抗力很弱，且眼内屏障结构限制了药物在眼内的分布，...     

两种术式治疗糖尿病视网膜病变合并白内障疗效比较

目的探讨超声乳化玻璃体切除＋人工晶体植入术、晶状体玻璃体切除＋人工晶体植入术治疗糖尿病视网膜病变（DRP）合并白内障的临床疗效。方法将58例DRP合并白内障患者分为A组28例（32眼）、B组30例（34眼）,A组行超声乳化玻璃体切除＋人工晶体植入术,B组行晶状体玻璃体切除＋人工晶体植入术。结果术后随访1-3 a,A组视力改善26眼,B组20眼;A组出现黄斑水肿、虹膜新生血管者分别为5、0眼,B组分别为11、5眼,两组比较均有统计学差异（P均〈0.05）。结论超声乳化玻璃体切除＋人工晶体植入术治疗DRP合并白内障疗效好,并发症少。     

玻璃体切割联合超声乳化人工晶状体植入术治疗玻璃体视网膜病变

对合并不同程度白内障的玻璃体视网膜病变患者30例（31眼）实施玻璃体切割联合晶状体超声乳化人工晶体植入术,其中气体填充15眼,硅油填充8眼。术后随访3～24个月。结果：术后24眼（77．4％）视力不同程度的提高,不变5眼,下降2眼。认为玻璃体切割联合晶状体超声乳化人工晶体植入术治疗合并不同程度白内障的玻璃体视网膜病变是安全、有效的。     

青光眼滤过术后迟发性眼内炎临床分析

目的总结青光眼滤过术后迟发性眼内炎的病因、治疗方法及预后。方法对5例青光眼滤过术后迟发性眼内炎患者的临床资料作回顾性分析。结果 5例（5眼）迟发性眼内炎发生于青光眼滤过术后5个月～8 a,均发生于薄壁滤过泡患者。5例房水及结膜囊分泌物培养,发现金黄色葡萄球菌和表皮葡萄球菌各1例。均行局部广谱抗生素治疗,1例行玻璃体切割联合玻璃体腔注药治疗。眼内炎症均控制,但患者视力较差。结论青光眼滤过术后迟发性眼内炎的发生与薄壁滤过泡密切相关,有的脓液中可培养出致病菌。局部抗炎联合玻璃体切割治疗有效,但患者视力预后较差。     

玻璃体切除术联合硅油填充术治疗无视网膜脱离的儿童外伤性眼内炎的疗效观察

目的:研究玻璃体切除术联合硅油填充术治疗无视网膜脱离的儿童外伤性眼内炎的临床效果。方法:选取收治的15例(15只眼)无视网膜脱离的外伤性眼内炎患儿作为试验组,并选取同期的15例(15眼)设为对照组。试验组采用标准三通道玻璃体切除术与硅油填充术治疗,对照组采用玻璃体切除术与抗生素注入治疗,观察治疗效果。结果:试验组11例患儿视力有提高,2例不变,1例下降,1例未能确定;参照组5例视力提高,6例不变,4例下降。结论:对于无视网膜脱离的儿童外伤性眼内炎,玻璃体切除术联合硅油填充术可取得良好的效果。     

人工晶体视区后囊膜嵌顿在儿童白内障手术中的应用

目的　探讨儿童白内障摘除术后的后囊处理方法。方法　对 2 7例 (33眼 )儿童白内障手术中采用后囊连续环形撕囊联合人工晶体视区后囊嵌顿 ,术后随访 (11± 3 2 1)个月。结果　 2 1眼玻璃体前界膜完整 ,人工晶体视区后囊嵌顿成功 ,其中 2眼术后 3个月视轴区玻璃体前界膜轻度浑浊 ,其余 19眼视轴区保持透明。结论　后囊连续环形撕囊联合人工晶体视区后囊嵌顿是预防儿童白内障人工晶体植入术后后囊浑浊 ,减少对玻璃体、视网膜干扰的可行方法。     

超高龄白内障患者人工晶状体植入术疗效观察

目的：探讨基层医院对90岁以上超高龄白内障患者进行小切口白内障囊外摘除术联合人工晶状体植入术的可行性、安全性、疗效和体会。方法回顾性分析2007-10～2012-10该院对90岁以上超高龄白内障患者43例（52眼）进行小切口白内障囊外摘除＋人工晶状体植入术的麻醉效果、手术安全性和临床效果进行分析。结果43例（52眼）白内障患者均顺利完成手术,术后视力恢复良好,术后1周矫正视力≥0.5者37眼（71.2％）,矫正视力在0.1～0.3者10眼（19.2％）,0.05～0.08者5眼（9.6％）,术后随访均无视网膜脱离、眼内炎、继发青光眼、角膜内皮失代偿和人工晶状体脱位等严重并发症发生。结论在基层医院对超高龄白内障患者实施小切口白内障囊外摘除术联合人工晶状体植入术,切口愈合快,术后反应小,术后散光小,易于操作,费用低,只要把握好适应证,同样可取得良好的效果。     

糖尿病性白内障超声乳化术的临床观察

目的探讨糖尿病性白内障行超声乳化吸出及人工晶体植入术的临床效果。方法对52例（62眼）糖尿病性白内障与同时期52例（60眼）老年性白内障行超声乳化吸出联合人工晶体植入术进行临床分析与比较。结果糖尿病性白内障术后并发症多,但经术后积极正确处理均能得到控制,视力恢复满意。结论白内障超声乳化吸出及人工晶体植入术治疗糖尿病性白内障是安全有效的。     

AcrySof Toric人工晶体治疗术前存在角膜散光的白内障短期临床疗效

目的观察术前存在角膜散光的白内障患者进行白内障超声乳化联合植入AcrySof Toric人工晶体（toric intraocular lens,IOL）后视力、矫正散光的有效性及稳定性的短期疗效。方法选择术前带有角膜散光（大于1．2D,小于3．0D）,年龄61～75岁,平均（67．5土7．5）岁,晶状体混浊Ⅱ～Ⅳ级的的白内障患者20例（25只眼）为研究对象,进行白内障超声乳化联合植入AcrySof Toric IOL（T3-T5）,术后第1d、1w、1m、及3m分别检查裸眼视力（UCVA）,最佳矫正视力（BCVA）,复查角膜曲率和角膜地形图,观察人工晶体轴向的位置,散瞳通过裂隙灯观察人工晶体标记线与角膜缘标记位置的方法确定人工晶体转动度数。结果术后第1d、1w、1m、3m裸眼视力为0．67±0．15、0．635=0．21、0．64±0．17、0．64土0．19,最佳校正视力分别为0．72±0．23、0．71±0．30、0．74±0．16、0．73±0．20,平均存在散光分别为（0．78±0．35）D、（0．82±0．37）D、（0．81±0．28）D、（0．77±0．33）D,散瞳查AcrySofToric IOL平均轴位偏转为（3．72±1．41）度、（3．63±1．61）度、（3．66±1．53）度、（3．75±1．45）度,各个时间段裸眼视力、最佳矫正视力、散光及轴位旋转无明显差异（P值均大于0．05）。结论对于术前存在角膜散光的白内障患者,植入AcrySof Toric IOL能有效的提高视力、矫正术前角膜散光,而且稳定性较好。     

角膜地形图引导超声乳化治疗2型糖尿病年龄相关性白内障

目的观察角膜地形图引导超声乳化治疗2型糖尿病年龄相关性白内障患者角膜散光及泪膜稳定性。方法术前存在角膜散光的2型糖尿病年龄相关性白内障患者80例(80眼),随机分为A、B组,各40例(40眼)。A组采用常规上方透明角膜切口行超声乳化白内障吸除联合人工晶状体(IOL)植入术,B组在角膜地形图引导下作切口行超声乳化白内障吸除联合IOL植入术,术后l周及3个月复查角膜地形图并观察泪膜改变情况。结果角膜垂直散光失量J0和水平散光失量P,A组术前与术后1周相比,P<0.01,与术后3个月相比,P>0.01;B组术前与术后l周和3个月相比,P均<0.01。两组术后1周泪膜破裂时间(BUT)明显缩短,与术前相比,P均<0.05,但B组BUT较A组明显延长(P<0.05);术后3个月,两组BUT基本恢复至术前水平(P均>0.01)。结论对于合并角膜散光的2型糖尿病年龄相关性白内障,在角膜地形图引导下作切口行超声乳化联合I0L植入术可以部分矫正患者术前的角膜散光,并可以较早稳定泪膜,提高患者的视觉质量。     

Motorized injector-assisted intrascleral intraocular lens fixation

For eyes with deficient capsular support, intraocular lens (IOL) implantation has long been a technical challenge. Recently, intrascleral fixation of the haptics of a three-piece posterior chamber IOL has become a popular option. In this procedure, externalization of the leading haptic during IOL injection is a stressful step. We present a modified technique to improve the ease and safety of this step. Our modified technique involves IOL injection with a motorized injector with several important modifications described here. With these modifications, a surgeon can easily maintain the correct orientation of the IOL in a well-controlled manner during IOL injection. The records of 13 patients who underwent this technique were retrospectively evaluated. Corrected-distance visual acuity improved significantly after surgery (p < 0.05). No postoperative retinal detachment, endophthalmitis, IOL decentration, or vitreous hemorrhage was noted during the follow-up period. In conclusion, the motorized injector-assisted intrascleral IOL fixation technique is a safe and effective alternative to the conventional procedure. This technique makes the process of leading haptic externalization easier and more controllable.     

Opacification of refractive bifocal intraocular lens in one month: Three case reports

Rationale:Multifocal intraocular lenses (IOLs) are used widely. However, the discovery of LS-313 MF15/30 (Oculentis B.V.) opacity during surgery has not yet been reported. This article reports 3 cases of LS-313 MF15/30 (Oculentis B.V.) IOL opacity found during cataract surgery implantation within 1 month.Patient concerns:Three patients underwent cataract surgery, and opacification of their IOL (LS-313 MF15/30, Oculentis B.V.) was found intraoperatively.Diagnosis:The patient was diagnosed with a postoperative intraocular opacity.Interventions:In case 1, the surgeon scrubbed the IOL with intraocular perfusion fluid and a gelatin sponge swab to reduce opacity in the central optical area of the IOL and then implanted it into the capsule bag. In case 2, the surgeon used the infusion-aspiration polishing mode for cleaning. To avoid IOL wear and bag damage, washing was stopped when turbidity in the center of the optical area was reduced. In case 3, we learned from our previous experience that the surgeon cut the IOL into 2 pieces and moved it out at the main incision, which was replaced and implanted with a brand new IOL, after the implanted IOL was again found cloudy.Outcomes:In case 1, more than 10 months after the surgery, the IOL was restored to transparency, no obvious eye discomfort was noted, and uncorrected visual acuity was 20/25. In case 2, the patient''s IOL surrounding area was still partially turbid after more than 10 months of follow-up. In case 3, the patient''s uncorrected visual acuity on postoperative day 1 was 20/20, and the best-corrected visual acuity was 20/20.Lesson:There are many reasons for the opacification of the IOL. In addition to the patient''s own factors, the material, production, and packaging of the IOL, as well as the influence of external environmental temperature, the influence of the IOL implant instrument should not be ignored and needs to be considered.     

A rare intraocular lens surface foreign body during phacoemulsification surgery: A case report

Rationale:Only a few cases of intraocular lens (IOL) opacification during phacoemulsification surgery have been reported in the literature; intraoperative emergency due to IOL surface foreign body is even rarer.Patient concerns:A 76-year-old woman underwent uncomplicated cataract surgery in her right eye. A triangular transparent seemingly foreign body tightly attached to the posterior surface of the IOL was found during IOL implantation; the IOL surface foreign body prevented the patient from obtaining satisfactory visual acuity after surgery.Diagnosis:IOL surface foreign body.Interventions:After confirmation of the surface foreign body by swept-source optical coherence tomography (IOL Master 700), the surface foreign body was removed in a second surgery. After surgery, the IOL was still well centered.Outcomes:Fortunately, the patient achieved distinctly improved vision without any visual disturbances in her right eye. To identify the material of the foreign body, it was examined by Fourier-transform infrared spectroscopy (FTIR).Lessons:This case suggests that surgeons should carefully observe IOLs before implantation. In addition, effective preoperative planning and skillful surgery can remove foreign bodies smoothly and improve patient vision.     

玻璃体切割、白内障摘除联合与分期手术对角膜内皮的影响

目的比较玻璃体切割、白内障摘除联合和分期手术对角膜内皮的影响。方法32例（32眼）患者,16例（16眼）行玻璃体切割联合自内障摘除术（联合手术组）,16例（16眼）行分期手术（分期手术组）。检测两组患者手术前后的角膜内皮细胞密度和六角形细胞。结果两组患者角膜内皮细胞密度手术前后及术后组间比较P均〉0．05;两组患者角膜内皮六角形细胞比例手术前后相比P均〈0．05,术后组间比较P〉0．05。结论联合和分期手术都会导致角膜内皮细胞的减少,改变角膜内皮细胞形态。联合与分期手术对角膜内皮的影响无明显差异。     

Case Report: Explantation of A Binkhorst Iridocapsular Lens >30 Years After Implantation in an Eye With Pseudoexfoliation Syndrome

An 86-year-old man with a Binkhorst 2-loop intraocular lens (IOL) that was implanted in the pupillary sphincter 33 years earlier was examined. The pupil of the implanted eye with the Binkhorst IOL was irregular and the eye had pseudoexfoliation (PEX) syndrome. Pupillary erosion resulted from rubbing of the IOL edge against the pupillary sphincter with PEX material. The IOL was removed because of visual distortion and intense pseudophakodonesis. Gross and light microscopic analyses showed no irido-fibro-lenticular adhesions over the lens or fragments of iris tissue attached to the lens. Scanning electron microscopy showed several pores of different sizes. No inflammatory cells were present, suggesting that the IOL was well tolerated.The case suggested that the pupillary ruff was not a good location for implantation of an IOL in an eye with PEX. Caution is recommended before implanting or suturing an IOL close to the pupillary border in eyes with PEX during cataract surgery.     

眼前节毒性反应综合征的研究进展

年龄相关性白内障是老年人常见的致盲疾病之一。主要治疗方法是超声乳化白内障吸除联合人工晶体植入术眼前节毒性反应综合征(TASS)是超声乳化白内障吸除联合人工晶体植入术后严重并发症之一,主要症状有眼前节无菌性炎症反应,可引起严重的角膜水肿、角膜内皮细胞数量减少、小梁网功能受损等。它具有复杂的发病原因,涉及手术相关的各个环节,与手术中使用的器械、药物和材料有密切的关系,容易与感染性眼内炎相混淆,临床诊断主要依靠特征性的临床表现及房水细菌学检查阴性进行鉴别诊断。TASS重在预防,治疗主要以糖皮质激素药物为主。