玻璃体切除联合硅油填充手术治疗急性感染性眼内炎

目的：研究玻璃体切除联合硅油填充手术治疗急性感染性眼内炎的临床效果。

方法：回顾性分析2008-01/2013-02我院收治的急性感染性眼内炎患者23例23眼临床资料,排除伴有球内异物的病例。所有患者均采用常规闭合三通道玻璃体切除联合硅油填充手术,其中6眼(并发外伤性白内障)联合Ⅰ期晶状体摘除+Ⅰ期人工晶状体植入术,3眼(并发外伤性白内障)联合Ⅰ期晶状体切除+Ⅱ期人工晶状体植入术, 4眼(硅油填充期间并发白内障)联合Ⅱ期晶状体摘除+Ⅱ期人工晶状体植入术,5眼(4眼外伤性眼内炎及1眼青光眼滤过泡漏致眼内炎)保留晶状体,1眼(白内障术后眼内炎)联合Ⅰ期人工晶状体取出+Ⅱ期人工晶状体植入,4眼(白内障术后眼内炎)保留人工晶状体。

结果：随访6～24mo,行玻璃体切除联合硅油填充手术的患者23例23眼眼内炎均得到有效控制,21眼(91%)患者视力不同程度提高。有2眼玻璃体切除术后眼压≥30mmHg,1眼行硅油取出术后眼压恢复正常,另1眼取硅油术后眼压仍高,需应用降眼压药物控制。

结论：急性感染性眼内炎患者及时行玻璃体切除联合硅油填充手术治疗,能有效控制眼内炎,提高患者视力。     

Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

AIM: To investigate the clinical features, causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens (IOL) removal in the treatment of acute-onset endophthalmitis after cataract surgery (APCE). METHODS: We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018. Data on the clinical features, causative organisms, visual acuity, intraocular pressure (IOP) and complications were collected. The mean follow-up period was 25.5mo. RESULTS: The mean age of the patients was 71.4y. The mean time between cataract surgery and the onset of endophthalmitis was 2.0d. Preoperative visual acuity ranged from no light perception to hand motion. After vitrectomy, the visual acuity increased in nine eyes (90%), and was unchanged in one eye (10%). A significant difference was observed between the mean preoperative (36.3±7.1 mm Hg) and postoperative IOP (14.9±4.3 mm Hg, P<0.05). Staphylococcus epidermidis was isolated in 5 eyes, S. aureus in 2 eyes, and Enterococcus in 1 eye. Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye. No retinal detachment or ocular atrophy was observed during the follow-up period. CONCLUSION: Under systemic antibiotic treatment and timely diagnosis, vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.     

玻璃体切割术治疗眼内炎的临床分析

目的 探讨眼内炎的病因构成及玻璃体切割术治疗眼内炎的临床效果。 方法 对我院1999年1月～2001年12月收治的眼内炎患者53例54只眼进行回顾性分析，男38例，女15例，年龄1～74岁，平均年龄32岁。对2例（2只眼）炎症较轻的患者仅采用药物治疗，5例（5只眼）视力无光感，炎症反应重的患者行眼球内容物剜除术，其余46例（47只眼）均采用常规三通道玻璃体切割术。随访2～32个月,平均10.5个月。 结果 眼球穿通伤导致的眼内炎共32只眼，占59.26%。内源性眼内炎8只眼，占14.81%。与白内障手术相关的眼内炎共7 只眼，占12.96%，青光眼手术晚期滤泡感染2只眼，占3.70%。玻璃体切割术后3只眼，占5 .56%。放射状角膜切开术（radial keratotomy,RK）后1只眼，占1.85%。原因不明1只眼，占1.85%。经治疗后患者视力明显提高（P=0.003）。3 d内行玻璃体切割术患者的视力恢复明显高于3 d后的患者（P=0.014），7 d内行玻璃体切割术患者的视力恢复明显优于7 d后的患者（P=0.021）。功能成功（视力≥0.02）37只眼,占68.52%；解剖成功（视力＜0.02，眼球结构完整）47只眼,占87.04%，脱盲（视力≥0.05）27只眼, 占50.00%。 结论 眼球穿通伤，尤其是伴有眼内异物存留者是导致眼内炎的最主要原因，尽早行玻璃体切割术是治疗眼内炎的理想方法。 （中华眼底病杂志，2003，19：93-95）     

感染性眼内炎玻璃体切除术后视网膜脱离

目的 探讨感染性眼内炎术后并发视网膜脱离的原因和防治方法。方法 回顾性分析34例(34眼)感染性眼内炎经玻璃体切除治疗后发生视网膜脱离的临床资料。结果 33眼的眼内炎症得到控制(97．06％)。24眼视网膜完全复位(75．00％)，4眼限局性脱离(12．50％)，3眼完全脱离(9．38%)，另1例眼内炎未控制(3．12％)。56．3％的患者视力可以达到0．02以上。结论 医源性裂孔是感染性眼内炎术后视网膜脱离最常见的原因。视网膜脱离出现后经过积极治疗可以改善预后。同时，应从各个方面避免视网膜脱离的发生。     

玻璃体切除联合眼内注射万古霉素治疗白内障术后眼内炎

目的:观察玻璃体切除联合眼内注射万古霉素治疗白内障术后眼内炎疗效。方法:回顾性分析白内障术后并发感染性眼内炎患者11例11眼,观察其发生时间及房水、玻璃体细菌和真菌培养结果,经玻璃体切除后玻璃体腔内注射万古霉素,观察其眼部情况、最佳矫正视力。随访8mo～7a,平均28.6mo。结果:G+球菌4例,G-杆菌1例,病原菌检出率为45%。至随访结束术后视力提高2行以上的有9眼,占82%,视力无明显改变2眼,占18%;末次随访11眼玻璃体腔均清亮,无1例患者出现视网膜脱离等眼底并发症。结论:白内障术后眼内炎选择玻璃体切除术联合玻璃体腔内注射万古霉素是安全可靠的方法。     

Diagnostic and therapeutic vitrectomy for endophthalmitis.

The introduction of a compact portable vitreous suction cutter enables the aspiration and resection of infected ocular tissues for diagnostic and therapeutic purposes. Four cases of postoperative bacterial endophthalmitis are presented in which mechanical anterior vitrectomy was performed in addition to conventional antimicrobial therapy. Three of these eyes were saved and 2 retained the possibility of useful vision. A rationale for the aggressive managements of endophthalmitis is presented.     

玻璃体切割手术联合眼内填充治疗重症眼内炎的疗效观察

目的 观察玻璃体切割手术联合眼内填充治疗重症眼内炎的临床效果.方法 回顾分析临床确诊为重症眼内炎的66例患者66只眼的临床资料.其中,外伤性重症眼内炎44例44只眼,内眼手术后重症眼内炎22例22只眼.所有患者均行玻璃体切割手术联合眼内填充治疗.66只患眼中,手术中摘除球内异物者19只眼,摘除晶状体者25只眼,摘除人工晶状体者6只眼,巩膜环扎者16只眼;行硅油填充者52只眼,行C3F8填充者14只眼.手术后随访时间2.0～25.0个月,平均随访时间7.9个月.对比分析手术前后视力和眼压变化情况.结果 所有患者炎症均得到控制,治疗有效率为59.10%.随访期间无眼内炎复发和视网膜脱离发生.66只患眼中,58只眼视力提高,占87.90%;5只眼视力不变,占7.60%;3只眼视力下降,占4.55%.手术后视力较手术前明显提高,差异有统计学意义(x2=45.27,P＜0.05).手术后眼压较手术前增高,差异也有统计学意义(t=-3.23,P=0.02).结论 玻璃体切割手术联合眼内填充是治疗重症眼内炎的有效方法.     

Endoscopy-assisted vitrectomy for treatment of severe endophthalmitis with retinal detachment

Summary statement

To decrease evisceration of eyes, endoscopy-assisted pars plana vitrectomy is a choice for patients with severe endophthalmitis accompanied with retinal detachment and corneal edema.

Purpose

To evaluate surgical outcomes using an intraocular videoendoscope for vitrectomy in patients with severe endophthalmitis with retinal detachment.

Methods

From December 2006 to August 2009, the medical records of 21 patients undergoing endoscopy-assisted vitrectomy for endophthalmitis with retinal detachment were studied. Only patients with ≥18 months follow-up were included.

Results

Intraocular infections were under control in 19 of the 21 patients. Postoperatively, the visual acuity of three of the patients ranged from 2/100 to 20/100 (14.3 %), two of the patients left with finger counting (9.5 %), eight had hand motion (38.1 %), six had light perception (28.6 %), and the other two had their eyes eviscerated (9.5 %) because of recurrent and uncontrollable infection.

Conclusions

In patients with severe endophthalmitis accompanied with retinal detachment and marked corneal opacity, it is appropriate to conduct endoscopy-assisted pars plana vitrectomy to decrease evisceration of eyes.     

Intraocular lens removal or not during vitrectomy for acute infectious endophthalmitis after cataract surgery

At present, the incidence of infectious endophthalmitis after cataract surgery has been significantly reduced, but it is still a serious complication. Removal or not of the intraocular lens (IOL) during vitrectomy in cases with a moderate or severe inflammation is controversial. In order to call upon more discussion, we publish the article entitled “Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery” written by Guo et al in this issue. With recent advanced vitrectomy techniques, and critical measures for management of risk factors related to occurrence of infection, IOL remaining during timely vitrectomy for acute endophthalmitis can possibly be safe and effective in selected cases.     

Management of endophthalmitis with pars plana vitrectomy.

Pars plana vitrectomy with intravitreal antibiotics is an effective technique in the treatment of culture-proved endophthalmitis. Best results are obtained when the therapy is instituted early in the course of infection, preferably during the first 36 hours of the onset of symptoms, and when the infective organism is of low virulence. In our 20 cases of culture-proved endophthalmitis 17 eyes (85%) were saved and had some degree of useful vision. Thirteen (65%) eyes had a visual acuity of 20/400 or better. Three eyes (15%) were lost.     

Intravitreal moxifloxacin injections in acute post-cataract surgery endophthalmitis: Efficacy and safety

Purpose:The aim of this study was to evaluate the efficacy and safety of intravitreal moxifloxacin injections in the treatment of acute post-cataract surgery endophthalmitis with visual acuity equal to or greater than hand movements.Methods:Fifty two patients with post-cataract surgery endophthalmitis who presented within 6 weeks with visual acuity equal to or greater than hand movements received two intravitreal moxifloxacin injections 48 h apart. Patients with prior history of ocular disease or treatment were excluded. Patients were followed up to 3 months either for resolution of endophthalmitis or worsening of disease. Number of patients who achieved visual acuity equal to or better than 20/40 and 20/200 at the third-month follow-up visit were compared with the number of patients at presentation, using Chi-square test. In addition, pretreatment LogMAR visual acuity at the time of presentation was compared with posttreatment visual acuity at end of third month using paired t test.Results:Fifty (96.15%) patients showed complete resolution of endophthalmitis while three patients required vitrectomy. Forty-one (78.85%) and 49 (94.23%) patients achieved visual acuity equal to or better than 20/40 and 20/200, respectively, at the third-month follow-up visit as compared to eight (15.38%) and 13 (25%) patients, respectively, at presentation (P < 0.05). In addition, mean LogMAR visual acuity at the time of presentation was 0.755 which improved to 0.307 at the third-month follow-up visit (P < 0.05). None of the patients developed hypersensitivity reactions to intravitreal moxifloxacin.Conclusion:Intravitreal moxifloxacin injections showed promising results in acute post-cataract surgery endophthalmitis.     

Treatment of endophthalmitis with and without pars plana vitrectomy

Two series of patients with endophthalmitis were compared. In the group treated with antibiotics or fungistatics, only 1 eye (4.3%) could be salvaged, whereas in the group with pars plana vitrectomy and antibiotics or fungistatics, 7 eyes (33%) had adequate visual acuity afterwards.     

眼内窥镜引导下彻底的玻璃体切割手术治疗伴有角膜混浊的外源性眼内炎

目的 观察眼内窥镜引导下彻底的玻璃体切割术治疗伴有角膜混浊的外源性眼内炎的临床特点。 方法 回顾分析我院行眼内窥镜引导下行彻底的玻璃体切割术的伴有角膜混浊的外源性眼内炎连续20只眼的临床资料。其中，男18例，女2例。年龄5～79岁，平均年龄35.9岁。眼球穿通伤所致眼内炎16例，人工晶状体植入手术后眼内炎4例。手术前视力均≤数指，角膜均严重混浊。 手术中均制造玻璃体后脱离，尽量彻底切割虹膜前后渗出膜、基底部和睫状体平部的玻璃体以及睫状体膜。入院到手术治疗的时间中位数为1.5 d。手术后平均随访23个月。 结果 手术中取玻璃体样培养阳性者9例，占45%；6例取出眼内异物共7枚。手术中锯齿缘离断1处者2例，医源性视网膜裂孔1处和2处者各1例。手术后再次玻璃体内注药和玻璃体切割手术各2例。手术后视力≥0.05者10例，占50%。除1例视力下降低、3例视力无明显变化外，16例手术后视力有不同程度的提高，其中4例≥0.8。手术后11例角膜基本恢复清亮。9例硅油存留，其中2例眼压偏低，但均>5 mm Hg（1 mm Hg=0.133 kPa ），1例高眼压，药物控制；局限性视网膜脱离和可疑视网膜脱离各1例，未再手术。9只硅油填充眼随访末期视力均≤数指，无硅油存留的11只眼中仅1只眼未达到0.05。无眼球丧失 。 结论 眼内窥镜引导下彻底的玻璃体切割手术为及时治疗伴有角膜混浊的外源性眼内炎的安全、可靠的新选择。 （中华眼底病杂志，2008，24：202-205）     

Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis

PURPOSE: To determine the role of pars plana vitrectomy (PPV) in the treatment of Klebsiella pneumoniae endogenous endophthalmitis. METHODS: Records of seven consecutive patients (10 eyes) diagnosed with Klebsiella endogenous endophthalmitis were retrospectively reviewed. RESULTS: Five patients (71%) had diabetes, and four (57%) had a liver abscess as the source. In most cases, the inflammation progressed within days and resulted in decreased vision worse than hand motions and a total vitreous abscess, despite systemic and intravitreal antibiotic injections. A PPV with subretinal abscess drainage and silicone oil tamponade was performed within 2 weeks. After 6 months, the retina remained attached in all eyes (100%), and vision was counting fingers or better in five eyes (50%). Two eyes recovered visual acuity between 20/63 and 20/125. CONCLUSIONS: Physicians should be alerted to the development of endogenous endophthalmitis in patients with Klebsiella septicemia, especially in diabetics with a hepatobiliary abscess. Aggressive therapy, including early vitrectomy with antibiotic injection, may improve the final outcome in this otherwise devastating ocular condition.     

急症玻璃体切割联合晶状体切除、硅油填充手术治疗内源性眼内炎

目的 观察急症玻璃体切割联合晶状体切除、硅油填充手术治疗内源性眼内炎的效果.方法 对28例内源性眼内炎患者30只眼的临床资料进行回顾性分析.所有患者均无眼部外伤史和内眼手术史.就诊时无全身症状者21例;发热者3例;眼胀痛伴头痛者2例;腹部疼痛者2例.均进行最佳矫正视力、眼压、裂隙灯显微镜、直接和间接检眼镜检查及眼B型超声检查后确诊.无发热、全身情况暂时稳定患者25只眼明确诊断后急症进行玻璃体切割联合晶状体切除、硅油填充术治疗;全身情况不稳定同时有发热或腹痛患者5只眼经相关科室治疗后立即行玻璃体切割联合晶状体切除、硅油填充手术治疗.所有患者治疗前均常规抽取玻璃体积脓送细菌培养加药物敏感试验及真菌培养加药物敏感试验.手术后随访18～30个月,观察分析手术前后视力、眼压改善情况及眼球保留情况.结果 30只眼中,手术后炎症控制,保留眼球者28只眼,占93.3%;手术后玻璃体再次积脓,眼压不能控制,行眼内容剜除手术者2只眼,占6.7%.手术后1、18个月视力与手术前视力比较,差异有统计学意义(x2=19.87,32.44;P＜0.01).手术后眼压正常者24只眼,占80.0%;出现一过性眼压升高者6只眼,占20.0%.一过性高眼压者经治疗后眼压控制在正常范围,与手术前眼压比较,差异有统计学意义(x2=7.43;P＜0.05).28份玻璃体标本中,培养结果阳性者12例,致病病原体检出率为42.9%.其中,细菌7例,占培养结果阳性者58.3%;真菌5例,占培养结果阳性者41.7%.28例患者中,合并肝胆系统感染者18例,占64.3%.结论 急症玻璃体切割联合晶状体切除、硅油填充手术是治疗内源性眼内炎的有效方法.     

Outcome of 23-gauge sutureless transconjunctival vitrectomy for endophthalmitis

PURPOSE: To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis. METHODS: Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period. RESULTS: 23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was -4.2 mmHg compared to the preoperative IOP (P=0.239). Final VA improved significantly compared to preoperative VA (P=0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%). CONCLUSIONS: 23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.     

眼内炎病因学回顾性分析和玻璃体切割术的治疗作用

目的 探讨眼内炎的病因以及玻璃体切割术治疗眼内炎的临床疗效。方法 对我院2001年1月～2003年1月收治的眼内炎患者共46例48眼进行回顾性分析，男35例37眼，女11例11眼，年龄2～59岁，平均37．4岁。除2例患者因眼内炎症过重行眼内容物摘除术外，其余患者均行玻璃体切割术。随访4～28个月，平均15．1个月。结果 因眼球穿通伤所致眼内炎30例32眼，内源性眼内炎7例7眼，白内障术后6例6眼，玻璃体切割术后1例1眼。不明原因2例2眼。经玻璃体切割术后视力均有不同程度提高。结论 眼球穿通伤是眼内炎的最主要原因，及早行玻璃体切割术对取得较好疗效具有重要作用。