人工晶体植入术后绿脓杆菌性眼内炎的临床分析

人工晶体植入术后绿脓杆菌性眼内炎的临床分析罗陈川洪荣照吴国基厦门市开元眼科医院（３６１００１）白内障囊外摘除联合人工晶体植入术后。眼内炎是最严重的并发症。其中绿脓杆菌感染，常造成视力丧失。现将３例人工晶体植入术后绿脓杆菌性眼内炎报告如下。例１男４６岁...     

人工晶体植入术后眼内炎四例

人工晶体植入术后眼内炎四例赵培泉，王文吉眼内炎是人工晶体植入术后最严重的并发症，其发生率虽低，但常导致视力丧失。我们自１９９０年１月至今遇到４例，报告如下。例１男，６８岁，因右眼红、痛伴视力下降１天入院。２年半前在本院行右眼白内障囊外摘除并后房型人工...     

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。     

肯内异物致外伤性白内障人工晶体植入术

目的 评估眼是物取出联合白内障摘除及人工晶体植入的效果。方法 １７例在取眼内异物同时联合白内障摘除人工晶体植入（Ｉ组），１９例在眼内异物取出一月后行白内障摘除人工晶体植入（Ⅱ组）。术后随访１－２４月。结果 术后矫正视力≥０．５者，Ｉ组９例，Ⅱ组８例。结论对于伤势较轻的眼内异物并外伤性白内障，眼内民物取出联合白内障摘除及人工晶体植入术是可行的手术方法。     

一次性注射器致儿童眼外伤的治疗观察

一次性注射器致儿童眼外伤的治疗观察张军和作者单位：２５００１２山东医科大学附属医院眼科近３年来，我们收治被一次性注射器针头扎伤眼球的患儿３７例，全部有眼内炎表现。其中５例因治疗及时炎症控制并做白内障摘除及人工晶体植入术，恢复了部分视力。余３２例眼内炎...     

眼内异物致外伤性白内障人工晶体植入术

目的评估眼内异物取出联合白内障摘除及人工晶体植入术的效果。方法17例在取眼内异物同时联合白内障摘除人工晶体植入（Ⅰ组），19例在眼内异物取出一月后行白内障摘除人工晶体植入（Ⅱ组）。术后随访1～24月。结果术后矫正视力≥0．5者，ⅠI组9例，Ⅱ组8例。结论对于伤势较轻的眼内异物并外伤性白内障，眼内异物取出联合白内障摘除及人工晶体植入术是可行的手术方法。     

厌氧菌性迟发型眼内炎

随着白内障囊外摘除手术的大量开展,人们逐渐注意到一种慢性迟发型眼内炎,致病菌是厌氧致病的痤疮丙酸杆菌(Propionibacteriumacnes),此慢性的眼内炎主要发生在白内障囊外摘除及后房人工晶体植入术后,也可以发生在眼外伤及其它内眼术后,其特点在于病程长,症状隐匿.此眼内炎在组织病理学、细菌学检查及治疗方法上都有其特点,逐渐引起了人们的重视.     

雷公藤多甙治疗人工晶体植入术后眼内炎症反应的临床研究

目的动态观察雷公藤多甙对人工晶体植入术后眼内炎症反应的影响,估价雷公藤多甙的临床治疗效果及其抗炎作用的机制。方法１２０例老年性白内障随机分为２组,施行白内障囊外摘除及后房型人工晶体植入术。１组为雷公藤多甙治疗组;２组为激素治疗组。术后１、３、７及１４天定量观察前房水混浊、人工晶体表面沉着物和纤维蛋白反应。结果雷公藤多甙治疗组术后第１、３、７及１４天房水混浊、人工晶体表面沉着物和纤维蛋白反应低于激素治疗组（Ｐ＜０．０５）。结论雷公藤多甙能降低人工晶体植入术后眼前节炎症反应,雷公藤多甙治疗优于激素治疗。     

人工晶体植入术后迟发细菌性眼内炎

人工晶体植入术后迟发细菌性眼内炎大连市第三人民医院眼科张繁友，夏建平患者女６７岁住院号１２６８４１９９３年１２月３日因右眼老年性白内障入院。入院后５天在局麻下行右眼白内障囊外摘除及后房人工晶体植入术。术前体格检查及常规化验检查均正常。手术经过顺利，术...     

低分子量肝素预防人工晶体植入术后眼内纤维蛋白渗出的临床研究

目的：研究低分子量肝素对人工晶体植入术后眼内纤维蛋白渗出的预防作用。方法：１１０例老年性白内障随机分为２组，并盲法给药。在进行白内障囊外摘除及后房人工晶体植入手术中，对照组灌注液为乳酸钠林格氏液，ＬＭＷＨ组于灌注液中加入ＬＭＷＨ－速避凝，浓度为６ｕ／ｍｌ。术中观察眼内出血，术后１、３及７天观察眼内纤维蛋白渗出、房水混浊及眼内出血情况。结果：ＬＭＷＨ组术后第１、３、７天眼内纤维蛋白渗出及房水混浊轻于     

Stenotrophomonas maltophilia Endophthalmitis after cataract extraction

PURPOSE: To report the clinical course, treatment response, and prognosis of Stenotrophomonas maltophilia endophthalmitis following cataract extraction. METHODS: The clinical records of six cases of S. maltophilia endophthalmitis after cataract extraction were retrospectively reviewed. Data were collected for surgical characteristics, disease course, culture growth, antibiotic sensitivity of the pathogen, response to treatment, and final visual acuity. RESULTS: Four patients underwent uncomplicated cataract extraction with phacoemulsification (PHACO) and intracapsular intraocular lens (IOL) implantation. One case was complicated by inadvertent posterior capsular tear during PHACO and IOL implantation. One patient underwent a combined extracapsular cataract extraction (ECCE) with IOL implantation and trabeculectomy, but vitrectomy was also performed because of cortical material loss into the vitreous cavity after a capsular tear. Symptoms began between postoperative days 1 and 19. All patients underwent a vitreous tap and intravitreal injections of antibiotics. Medical therapy alone was sufficient in five patients to treat the infection. One patient had four episodes of recurrence. Pars plana vitrectomy with subsequent capsulectomy and IOL extraction were performed in this patient to complete remission. CONCLUSION: S. maltophilia should be considered a pathogenic organism possibly causing endophthalmitis after PHACO+IOL implantation. The clinical picture resembles acute bacterial endophthalmitis. When the pathogen has settled in the capsular bag, the infection may persist and become refractory to medical treatment.     

Enterococcal endophthalmitis following cataract surgery

BACKGROUND: Postoperative endophthalmitis can be subdivided into acute and chronic forms which are typically caused by different organisms. Enterococcus faecalis is an organism which normally causes an acute form of endophthalmitis. PATIENTS AND METHODS: We report on four cases of different forms of endophthalmitis following cataract extraction and intraocular lens (IOL) implantation who had been referred to our institution between 1998 and 2001. Enterococcus faecalis was the causative organism in all of them. RESULTS: Two patients presented with an acute form and were immediately treated in our hospital after symptom onset utilizing pars plana vitrectomy with and without IOL explantation. The two other patients were initially treated with subconjunctival and/or systemic antibiotics and steroids over a period of about two months before referral to our hospital. After initial improvement the inflammation exacerbated in these two patients and vitrectomy with or without IOL and capsular bag explantation was performed. The explanted IOL and capsular bag of one patient were examined using scanning electron microscopy and it was shown that the enterococci were adherent to the IOL and the capsular bag. CONCLUSION:Enterococcus faecalis can be the causative organism both of an acute and of a recurrent form of postoperative endophthalmitis. The recurrent form may be caused by organisms which tend to adhere to the IOL and the capsular bag. This should be kept in mind when considering different treatment options.     

白内障摘除联合人工晶状体植入术后急性感染性眼内炎的临床观察

目的探讨白内障摘除联合人工晶状体(IOL)植入术后急性感染性眼内炎的治疗策略。 方法收集2011至2017年广州爱尔眼科医院收治并诊断为白内障摘除联合IOL植入术后发生急性感染性眼内炎的9例患者的临床资料。其中,在广州爱尔眼科医院进行白内障手术后发生眼内炎的患者1例,在基层医院行白内障手术后发生眼内炎的转诊患者8例。查阅患者的视力、眼压、眼前节、眼部B超扫描等检查结果。对患者行玻璃体切除术(PPV),并依据患者的感染情况行IOL取出＋硅油填充术。手术中常规取前房液和玻璃体液进行细菌和真菌培养。 结果在9例患者中,糖尿病患者1例,高血压患者2例,其余无长期全身疾病。本文中所有患者发生急性感染性眼内炎的时间均在白内障手术后1～9 d,表现为术眼剧痛、视力急剧下降、结膜充血水肿、角膜不同程度水肿、房水混浊伴或不伴前房积脓及出现前房渗出膜等症状。眼部B超检查结果显示患者的玻璃体混浊,眼底窥不见。在9例急性感染性眼内炎患者中,有8例患者及时进行PPV治疗,1例患者由于角膜混浊未能进行完整的PPV;7例患者术前曾行前房冲洗及取材行病理涂片,6例患者于PPV前进行玻璃体腔内注射万古霉素;术后早期有3例患者取出IOL联合硅油填充术,其余6例患者保留IOL以及眼内注药,无填充硅油。9例患者中有7例患者术后视力较术前有所提高,其中最佳矫正视力在0.01～0.09的有2例,在0.1～0.3的有3例,在0.3～0.5的有2例,1例患者术后视力无提高,1例患者由于感染不能控制,进行眼内容物剜除术。 结论PPV是白内障摘除术后急性感染性眼内炎有效控制感染的治疗方法。对于角膜条件相对较好的眼内炎患者积极行PPV是保留患者视功能的关键。     

人工晶状体植入术后急性眼内炎

目的 探讨白内障摘出联合人工晶状体植入术后急性眼内炎的临床特点、治疗方法及效果.方法 回顾性分析5848例白内障摘出人工晶状体植入术后发生急性眼内炎4例(4眼),眼内炎发生于术后2～6d,视力为光感～数指/10 cm.治疗方法:2例行玻璃体腔内注药术,其中1例效果欠佳,于次日行玻璃体切除联合玻璃体内注药;另2例行玻璃体切除术联合玻璃体腔内注药,均配合全身及局部应用抗生素及皮质类固醇类药物.结果 随访8～26个月,4例眼内炎均得到控制,最后视力分别为0.15、0.25、0.6、0.8.结论 白内障摘出人工晶状体植入术后急性眼内炎是白内障手术的严重并发症,玻璃体切除联合玻璃体腔注药是一种安全、有效的治疗方法.     

Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases

Sixteen cases of previously reported culture-proven Propionibacterium-associated endophthalmitis after extracapsular cataract extraction (ECCE) are reviewed. The inflammation was observed 2 to 10 months after surgery and occurred after laser posterior capsulotomy in four cases. Clinically, it appeared as a chronic iridocyclitis characterized by granulomatous-appearing keratic precipitates (5 cases), hypopyon (10 cases), and a white plaque on the posterior capsule or intraocular lens (IOL) implant (8 cases). Response to corticosteroid treatment was transient. Surgical intervention was required between 1 and 16 months after the inflammation began and included removal of the IOL and capsular bag via the limbus in 7 cases and pars plana vitrectomy in 11. Intravitreal antibiotics were administered in 12 cases. Postoperative visual acuity ranged from 20/20 to count fingers, with 11 of 16 patients recovering visual acuity of 20/40 or better. Propionibacterium-associated endophthalmitis should be suspected if chronic indolent intraocular inflammation develops after ECCE. Intraocular specimens should be obtained and submitted for aerobic and anaerobic culture and cytologic/histopathologic studies. Based on the clinical courses of these patients, recommendations for management are discussed.     

人工晶状体取出原因临床变化分析

目的:回顾性分析人工晶状体取出的原因,探讨人工晶状体取出原因的临床变化。方法:对25例25眼人工晶状体(IOL)取出的病例进行回顾性分析。结果:人工晶状体夹持偏心移位10例(40%);后囊破裂人工晶状体脱位和倾斜6例(24%);IOL度数错误3例(12%);IOL眼视网膜脱离2例(8%);IOL大泡性角膜病变1例(4%);眼内炎2例(8%);IOL混浊1例(4%)。植入与取出的时间间隔1d～10a。前房型IOL2例,后房型IOL23例。IOL置换12例。结论:目前,导致IOL取出的原因较以前发生了变化,主要包括IOL的偏心移位、IOL度数错误和IOL混浊等,进行IOL置换有利于视功能的改善。     

Treatment strategies for postoperative Propionibacterium acnes endophthalmitis

PURPOSE: Propionibacterium acnes endophthalmitis after cataract extraction and posterior chamber intraocular lens (IOL) implantation is characterized by a chronic indolent course, frequently associated with recurrence after standard endophthalmitis treatment. This study was designed to evaluate the efficacy of various therapeutic methods in the treatment of primary and recurrent episodes of postoperative P. acnes endophthalmitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-five patients treated at Wills Eye Hospital for P. acnes endophthalmitis. METHODS: The authors retrospectively reviewed the clinical charts and microbiology files of all patients treated at Wills Eye Hospital between January 1991 and April 1998 with culture-proven P. acnes endophthalmitis after cataract extraction and posterior chamber IOL implantation. MAIN OUTCOME MEASURES: Results of cultures and microbiologic examinations, efficacy of various treatment methods in the prevention of recurrent inflammatory episodes, and final visual outcome. RESULTS: Twenty-five patients who met inclusion criteria were identified; initial therapy consisted of 1 of the following: intraocular antibiotic (IOAB) injections alone (2 patients); IOAB combined with pars plana vitrectomy (PPV) (10 patients); IOAB and PPV combined with partial capsulectomy (9 patients); and IOAB, PPV, total capsulectomy, and IOL exchange (4 patients). Nearly half of the patients (10 of 21, or 48%) initially treated with IOAB alone (1 of 2), IOAB and PPV (5 of 10), and IOAB combined with PPV and partial capsulectomy (4 of 9) required further therapeutic interventions for recurrent disease. Retreatment with IOAB alone or combined with PPV and partial capsulectomy in these patients failed to eradicate the infection in three (75%) of four patients. None of the patients (0 of 4) treated initially with total capsulectomy and IOL exchange required additional surgical intervention. Furthermore, none of the patients (0 of 13) who underwent total capsulectomy with IOL removal or exchange or IOL exchange alone as an initial, secondary, or tertiary treatment required further intervention. CONCLUSION: In the authors' series, approximately half of the patients with P. acnes endophthalmitis were treated successfully initially with nonsurgical or limited surgical intervention. All patients treated with total capsulectomy and IOL exchange or removal, either as an initial treatment or for recurrent disease, were cured. Removal of the entire capsular bag and the IOL may be performed as a definitive initial therapy and should be performed for recurrent inflammation.     

Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery

The authors reviewed the incidence of hospital-linked postoperative endophthalmitis at the Bascom Palmer Eye Institute between January 1, 1984 and June 30, 1989. After 30,002 intraocular surgical procedures, the following incidence of culture-proven endophthalmitis was observed: (1) extracapsular cataract extraction (ECCE) with or without intraocular lens (IOL) implantation--0.072% (17 of 23,625 cases); (2) pars plana vitrectomy--0.051% (1 of 1974 cases); (3) penetrating keratoplasty (PKP)--0.11% (2 of 1783 cases); (4) secondary IOL--0.30% (3 of 988 cases); and (5) glaucoma filtering surgery--0.061% (1 of 1632 cases). A statistically significant (P = 0.038, Fisher's exact test, two-tailed) increased incidence of endophthalmitis occurred in diabetic (0.163%, 6 of 3686 cases) compared with nondiabetic (0.055%, 11 of 19,939 cases) patients undergoing ECCE with or without IOL implantation. The authors also reviewed the incidence of postoperative endophthalmitis after intracapsular cataract extraction (ICCE) with and without IOL and observed an incidence of 0.093% (7 of 7552) in cases operated on between September 1, 1976 and December 31, 1982.     

Endophthalmitis following cataract surgery

BACKGROUND: Infectious endophthalmitis is a serious complication following cataract surgery, since it often induces a substantial reduction of visual acuity. PATIENTS AND METHODS: We retrospectively evaluated the clinical data of 53 patients with endophthalmitis following cataract surgery who were treated at the department of ophthalmology of the University Hospital in Ulm between 1995 and May 2001.Of these patients, 50 had been referred.Clinical presentation, infecting organism, treatment and visual outcome were analysed with a followup ranging from 2 weeks up to 42 months (median: 6 months). RESULTS: In 52 patients endophthalmitis was preceeded by cataract extraction and IOL implantation, in one case by secondary IOL implantation.Confirmed microbiologic growth was demonstrated from intraocular specimens in 26 out of 41 operated eyes (63%), the most frequent causative organisms were coagulase-negative Staphylococci (50%). All isolated bacteria were sensitive to a combination of the antibiotics vancomycin and amikacin or vancomycin and ceftazidime. 13 patients were treated with intravenous antibiotic therapy alone. In 46% of patients, who were initially treated with intraocular antibiotic injections alone, required further therapeutic intervention for recurrent infection. Only 7.7% of the patients who initially underwent intraocular antibiotic injections combined with IOL removal or pars plana vitrectomy with or without IOL removal, required further surgical intervention. Initial visual acuity was hand movements (median) only but improved during follow-up to 0.2 (median). CONCLUSIONS: In this series all tested bacteria were susceptible to the combination of vancomycin with either amikacin or ceftazidime. Aggressive initial treatment including IOL removal may be associated with a lower frequency of recurrent disease.