兔玻璃体腔注射美罗培南治疗细菌性眼内炎

目的评价兔玻璃体腔注射国产美罗培南对敏感菌引起的眼内炎的疗效。方法选取健康成年日本大耳白兔24只，随机分为Ⅰ、Ⅱ两组，每组12只，分别玻璃体腔内接种金黄色葡萄球菌和绿脓杆菌建立相应的眼内炎模型。待出现典型眼内炎体征时，Ⅰ组和Ⅱ组再随机分为A、B组和C、D组。B、D组玻璃体腔均注射美罗培南1．25mg，A、C组分别注射万古霉素1．0mg和复达欣2．0mg作为对照。通过临床炎症评分、细菌培养阳性率、组织学检查病理评分等指标评估药物疗效。结果在两种眼内炎模型中，美罗培南用药后临床炎症评分均有显著下降，用药前后相比有统计学差异，但与万古霉素、复达欣相比无统计学差异；美罗培南用药后细菌培养阳性率在金黄色葡萄球菌和绿脓杆菌眼内炎模型中分别为0和16．7％，均低于万古霉素和复达欣，与万古霉素相比差异有统计学意义；用药2周后组织学检查显示绝大多数标本视网膜组织结构基本完整，层间有不同程度变性和坏死伴炎症细胞浸润，美罗培南与万古霉素、复达欣相比其视网膜病理评分均无统计学差异。结论兔玻璃体腔注射美罗培南治疗敏感金黄色葡萄球菌和绿脓杆菌引起的眼内炎，疗效分别与万古霉素、复达欣基本相当，但当眼内炎体征已明显时单次眼内用药很难完全控制炎症。     

Intravitreal taurolidine against experimental Staphylococcus epidermidis endophthalmitis in rabbits

PURPOSE: Taurolidine is a broad spectrum, non-antibiotic antimicrobial agent, not previously tested against infectious endophthalmitis. The efficacy of intravitreal taurolidine in the treatment of experimental Staphylococcus epidermidis endophthalmitis was evaluated and compared with vancomycin in a rabbit model. METHODS: The right eyes of 34 albino rabbits were infected with an intravitreal inoculum of S. epidermidis (10(5) colony-forming units/0.1 ml). The right eyes of four rabbits (group 7) were not infected and served as uninfected controls. 24 hours after inoculation of bacteria the animals were divided into the following treatment groups: group 1 (7 rabbits) received intravitreal taurolidine at 24 hours and group 2 (7 rabbits) received at 48 hours. Group 3 (7 rabbits) received vancomycin at 24 hours and group 4 (7 rabbits) at 48 hours. Group 5 (3 rabbits) received polyvinylpyrrolidone at 24 hours and group 6 (3 rabbits) at 48 hours. Clinical scoring was performed at 24, 48 and 72 hours. At 72 hours post inoculation, vitreous samples were collected for quantitative microbiological studies and then, the eyes were enucleated for histopathological scorings. RESULTS: The clinical and histopathological examinations revealed significant amelioration of inflammation in eyes treated with taurolidine and vancomycin when compared with polyvinylpyrrolidone. The eyes treated with taurolidine also had significantly lower colony forming units than the eyes treated with polyvinylpyrrolidone and taurolidine rendered many eyes sterile. CONCLUSION: Taurolidine is expected to be a potential agent for treatment of S. epidermidis endophthalmitis.     

Intravitreal antibiotic injection and vitrectomy in acute bacterial endophthalmitis.

Two days after an unplanned extra-capsular cataract extraction with sector iridectomy, a patient showed typical signs of bacterial endophthalmitis. Vitreous and aqueous were aspirated for culture, and gentamicin and dexamethasone were injected. Twenty-four hours later, after isolation of Staphylococcus epidermidis, a vitrectomy to remove the central vitreous was done. Postoperatively, vision progressively improved; at the last review nine months after vitrectomy, visual acuity was 20/50.     

头孢哌酮/舒巴坦玻璃体腔注射治疗兔铜绿假单胞菌性眼内炎

目的评价头孢哌酮/舒巴坦治疗铜绿假单胞菌眼内炎的疗效。方法青紫蓝兔18只,随机分为3组,右眼注菌后6h分别注入100g/L头孢哌酮/舒巴坦、22.5g/L头孢他啶和生理盐水各0.1mL,观察24h。另取青紫蓝兔12只,随机分为2组。早期注药组注菌后6h注入100g/L头孢哌酮/舒巴坦0.1mL,晚期注药组注菌后20h注入100g/L头孢哌酮/舒巴坦0.1mL,观察1周。结果头孢哌酮/舒巴坦组、头孢他啶组与生理盐水组比较除角膜评分外（P〉0.05）,结膜、前房、玻璃体、视网膜、B型超声检查及组织病理学评分结果差异均有统计学意义（P〈0.05）;头孢哌酮/舒巴坦组与头孢他啶组相比,除虹膜炎症反应评分差异有统计学意义外（P〈0.05）,其他评分差异均无统计学意义（P〉0.05）,但从具体评分来看头孢哌酮/舒巴坦组优于头孢他啶组。早期注药组与晚期注药组相比,1周后结膜、前房、虹膜、玻璃体、视网膜、B型超声检查及组织病理学评分差异均有统计学意义（P〈0.05）。结论 100g/L头孢哌酮/舒巴坦0.1mL玻璃体腔注射治疗早期铜绿假单胞菌眼内炎有效。     

经玻璃体腔内注射药物联合玻璃体切割术治疗真菌性眼内炎

目的：研究经玻璃体腔内注射伏立康唑及两性霉素B脂质体联合玻璃体切割术治疗真菌性眼内炎的效果。

方法：选取2014-09/2016-09本院眼科接受治疗的感染烟曲霉菌的真菌性眼内炎患者27例54眼为研究对象,随机分为对照组、研究1组、研究2组三组,每组9例。在行玻璃体切割术后,对三组患者进行药物敏感度实验,检测药物为两性霉素B脂质体和伏立康唑。之后对三组患者都应用伏立康唑口服,用阿托品膏散瞳,并且每天换药,另外对研究1组和研究2组患者的玻璃体腔内分别注入伏立康唑溶液和两性霉素B脂质体溶液。术后观察前房炎症情况、角膜混浊程度、玻璃体混浊情况和视力恢复情况。

结果：烟曲霉菌对两性霉素B脂质体和伏立康唑均敏感。三组患者术后不同时间角膜混浊情况的比较：除术后1d对照组分别与研究1组和研究2组差异无统计学意义外(P>0.05),其余术后时间比较差异均有统计学意义(P<0.05)。术后不同时间研究1组和研究2组角膜混浊情况比较差异无统计学意义(P>0.05)。三组患者术后不同时间房水闪辉情况的比较：除术后1d对照组分别与研究1组和研究2组差异无统计学意义(P>0.05),其余术后时间比较差异均有统计学意义(P<0.05)。研究1组和研究2组房水闪辉情况除术后9d和15d 差异有统计学意义(P<0.05),其余术后时间比较差异均无统计学意义(P>0.05)。三组患者术后不同时间玻璃体混浊情况的比较：对照组与研究1组除术后1d比较无统计学意义外,其余术后时间均有统计学意义(P<0.05)。对照组与研究2组比较除术后1、4、6d比较无统计学意义外,其余术后时间均有统计学意义(P<0.05)。研究1组和研究2组比较除术后6d有统计学意义(P<0.05),其余术后时间比较差异均无统计学意义(P>0.05)。

结论：经玻璃体内注射伏立康唑和两性霉素B脂质体联合玻璃体切割术可以有效地治疗真菌性眼内炎,与两性霉素B脂质体相比,伏立康唑对治疗早期和中期的真菌性眼内炎效果较好。     

Intravitreal cephalothin in experimental staphylococcal endophthalmitis

Intravitreal cephalothin was used to treat experimentally induced bacterial endophthalmitis in rabbit eyes. A dose of 2 mg and less was apparently nontoxic to all intraocular structures. Thirty-two hours after injection of a 2 mg dose, the level remaining in the vitreous was above the minimal inhibitory concentration for most susceptible organisms. Treatment of experimentally induced staphylococcal infections of the vitreous was successful with early intravitreal injection. When therapy was delayed, vitreous bands and posterior lens cataracts developed. Eyes of control animals receiving intramuscular and subconjunctival injections of cephalothin all progressed to phthisis bulbi.     

Intravitreal pefloxacin therapy in postoperative endophthalmitis

Purpose : To study the efficacy of intravitreal pefloxacin in the management of suspected bacterial endophthalmitis. Methods : Twenty eyes with suspected postoperative bacterial endophthalmitis were given an intravitreal injection of pefloxacin (200 μg in 0.1 mL). If required the injection was repeated after 24 h. The main parameters evaluated were visual acuity, response to intravitreal therapy and any complications due to intravitreal pefloxacin. Results : Fourteen eyes (70%) responded to intravitreal pefloxacin therapy alone, while an additional pars plana vitrectomy was required in six eyes (30%). Nineteen eyes retained a visual acuity of 6/60 or better at 3 months after the initiation of therapy. A retinal detachment developed in one of the eyes which received intravitreal therapy. Conclusions : Intravitreal pefloxacin may be a useful alternative therapy in bacterial endophthalmitis.     

Intravitreal oxacillin in experimental staphylococcal endophthalmitis

Summary We compared combined intravitreal and systemic oxacillin to combined subconjunctival and systemic oxacillin in the treatment of experimental staphylococcal endophthalmitis. Intravitreal injection of 500 mcg was nontoxic to all intraocular structures and produced concentrations in the vitreous bactericidal to all susceptible strains of Staphylococcus aureus for almost 24 hours. In eyes treated 8, 10, and 12 hours after intravitreal inoculation of 10000 to 20000 penicillinase-producing S. aureus organisms, intravitreal injection of 500 mcg of oxacillin was superior to subconjunctival injection of 100 mg when each was combined with seven days of intensive intramuscular oxacillin.

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Zusammenfassung Zur Behandlung einer experimentellen Staphylokokken-Endophthalmitis wurde eine Kombination von intravitrealem und intramuskulärem Oxacillin mit einer Behandlung, bei der subkonjunctivale mit intramuskulären Injektionen von Oxacillin kombiniert wurden, verglichen. Die Injektion von 500 g in den Glaskörper verursachte keinen intraokulären Schaden und erzeugte eine Glaskörperkonzentration, die für fast 24 Std die empfindlichen Kolonien des Staphylococcus aureus töten konnte. Penicillinase produzierender Staphylococcus aureus (10000–20000 Organismen) wurde in den Glaskörper injiziert. Die Augen wurden dann nach 8,10 und 12 Std behandelt. Eine Injektion von 500 g Oxacillin in den Glaskörper war erfolgreicher als eine Injektion von 100 mg unter die Bindehaut, wenn beide Methoden mit einer 7 Tage währenden intramuskulären Oxacillin-Therapie verbunden waren.

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This study was supported in part by Public Health Service grant 1107-03 and Illinois Lions Club.     

Intravitreal gas injection for the treatment of experimental vitreous hemorrhage in rabbits

PURPOSE: To determine the effectiveness of intravitreous gas injection in the management and clearing of experimental vitreous hemorrhage. METHODS: A total of ten New Zealand white rabbits received an injection of 0.4 ml of autologous blood into the vitreous of the right eye. After 24 hours of the vitreous hemorrhage simulation, six eyes were randomly assigned for treatment with na intravitreous injection of 0.2 ml of 100% perfluoropropane gas (C3F8) (group A), while four eyes received a control injection of an equivalent volume of balanced salt solution (group B). The persistence of vitreous opacification, which was graded at pre-established time points during 32 days of follow-up, was evaluated on the basis of visibility of retinal details in each of the four quadrants. RESULTS: In the gas-treated group (A), a partial view of the retina in the four quadrants was possible at 15 days, while at 32 days, the vitreous cavity was completely free of blood in all eyes, allowing unobstructed observation of the fundus. No retinal details could be observed in the control group after 32 days of follow-up. CONCLUSIONS: Gas injection proved effective in the treatment of experimental vitreous hemorrhage. It was significantly better than the injection of balanced salt solution, according to criteria of extension, intensity, and clearing time. Its technical facility, lack of complications, and low cost encourage additional research into gas injection to add knowledge to this initial study and to clarify its potential usefulness to treat persistent vitreous hemorrhage as well as to elucidate some unique pathophysiology features of blood catabolism in the vitreous.     

Intravitreal and subretinal proliferation induced by platelet-rich plasma injection in rabbits.

We developed an experimental model of proliferative vitreoretinopathy (PVR) in albino rabbits by combining some factors suspected of causing the disease. Sixty nine eyes divided into six groups served as controls (Groups C 1-6). Forty nine eyes were divided into four experimental groups (Groups E 1-4). Group E1 (n = 12) was injected with 0.15 ml of platelet-rich plasma. In addition, Groups E2 (n = 12) and E3 (n = 12) underwent cryotherapy or vitrectomy. Group E4 (n = 13) underwent both procedures. Seven of the 13 Group 4 experimental eyes developed total retinal detachment and giant holes. None of the other groups developed more than two total retinal detachments or giant holes (P < 0.05). Light and electron microscopy showed intravitreal or preretinal proliferation composed of fibroblast-like cells. Retroretinal membranes appeared only in Group E4 eyes, composed of elongated cells with oval nuclei and abundant organelles in the cytoplasm. We believe these lesions mimic human PVR more closely than other models previously developed.     

玻璃体腔注药治疗外因性眼内炎

目的 :评估玻璃体腔注药治疗外因性感染性眼内炎的疗效。方法 :回顾 1999年 7月～ 2 0 0 2年 2月我院收治的首诊时即给予玻璃体腔注药的外因性感染性眼内炎患者19例 19眼 ,平均年龄为 42 .4岁。其中白内障摘除联合人工晶体植入术后 5眼 ,眼球穿孔伤后 14眼。结果 :随访 5～ 35个月 ,玻璃体腔注药后炎症控制 9眼 ,治疗后视力在 0 .0 5以上者 8眼 ,有效率为 42 .1%。结论 :玻璃体腔注药治疗感染性眼内炎仍有一定的疗效     

Intravitreal corticosteroids in the treatment of exogenous fungal endophthalmitis.

A rabbit model of exogenous Candida albicans endophthalmitis was used to determine if intravitreal corticosteroids combined with an efficacious antifungal agent enhanced fungal proliferation and ocular destruction, or if the combination can suppress the inflammatory and immunogenic response that causes retinal and uveal destruction. Exogenous Candida albicans endophthalmitis was experimentally induced in 20 rabbit eyes. Eight eyes received intravitreal amphotericin B alone; eight eyes received amphotericin B plus dexamethasone. Four eyes served as controls. By clinical grading on the fourth day after infection, the vitreous of the eyes in the two drug-treated groups was significantly clearer in comparison to that of eyes in the control group. By the seventh day after infection, the eyes treated with amphotericin B plus dexamethasone had significantly clearer vitreous in comparison to the eyes receiving only amphotericin B (P = 0.0017). Quantitative culture results were negative in both treatment groups, and histopathologic examination confirmed the clinical grading. Contrary to current beliefs, there was no evidence that the addition of corticosteroids impaired antifungal activity or enhanced fungal proliferation.     

Intravitreal injection of endothelin-1 caused optic nerve damage following to ocular hypoperfusion in rabbits

The purpose of this study was to investigate the time course of the ocular hypoperfusion, retinal damage, and optic nerve damage induced by intravitreal injection of endothelin-1 (ET-1) in rabbits. ET-1, at 5 pmol (20 microL, twice a week for 2 or 4 weeks), was injected from the pars plana into the posterior vitreous of the right eye. Optic nerve head (ONH) blood flow and retinal artery diameter, together with the neurofilament light chain (NF-L) content, retinal morphology, and axon density of the optic nerve, were evaluated at 2, 4, and 8 weeks after the first injection of ET-1 (n=7 or 8). Tissue blood velocity in ONH was measured using a laser speckle method, and the diameter of major retinal arteries on the rim of the ONH was calculated from fundus photographs by a masked observer. Histological analysis and immunoblot evaluation of NF-L in the optic nerve were performed to evaluate optic nerve damage. At 2 weeks after the first ET-1 injection, tissue blood velocity was decreased by approximately 20% (versus the contralateral eye), and the diameter of retinal arteries had decreased by approximately 40%. These changes were sustained at the same level until 8 weeks after the first ET-1 injection. At 4 and 8 weeks after the first ET-1 injection, the amount of NF-L in the optic nerve was significantly less in the ET-1 treated eyes than in the contralateral eyes. At 8 weeks after the first ET-1 injection, a loss of myelinated axons and increases in gliosis and connective tissue were noted in the optic nerve of the treated eye, and the optic nerve-axon number had decreased significantly (each, versus the untreated eye). Retinal ganglion cells in the retina were not observed any damage at 2, 4, and 8 weeks after ET-1 injection. In conclusion, intravitreal injection of ET-1 induced chronic hypoperfusion in the ONH and retina, which presumably caused decreases in NF-L content and axon number in the optic nerve noted in the later part of the observation period.