抗青光眼小梁切除术后感染性眼内炎临床分析

目的 探讨小梁切除术后感染性眼内炎发生的临床特点、治疗方法和预后.方法 回顾性分析1999年1月至2009年12月中山大学中山眼科中心收治,并送病理科检查的12例小梁切除术后感染性眼内炎患者的临床资料,包括患者一般情况、抗青光眼手术情况、术后感染性眼内炎治疗前后的情况及病原学检查结果.结果 病理涂片检查及培养的病原体总检出率为66.7%,迟发性眼内炎者真菌检出率为22.2%.使用抗感染药物联合早期前房冲洗注药、经扁平部后段玻璃体切割术及玻璃体内注药可有效控制感染,治疗后所有患者前房积脓消失,房水闪辉阴性.44.4%的迟发性眼内炎患者治疗后视力提高,最佳矫正视力达到0.2.所有患者治疗后眼压均正常.结论 对于小梁切除术后感染性眼内炎,取材行病理涂片检查可早期诊断并提高病原体的检出率,经扁平部后段玻璃体切割术是有效的治疗方法,其预后与发病时视力、病原体种类及其毒力有关.     

出血性玻璃体混浊行玻璃体切除术后假性前房积脓分析

目的介绍一种发生于玻璃体切除术后的非感染性前房积脓现象，即假性前房积脓。方法收集我中心收治的需行玻璃体切除术的连续病例１２５０例，其中各种原因引起的玻璃体积血４１８例。术后发生假性前房积脓者７例，均为玻璃体积血者。主要治疗方法是前房冲洗及其自然吸收。结果假性前房积脓发生于术后３～５天，呈泥沙样沉积，局部抗生素及激素加强治疗无效。眼内穿刺行涂片、细菌和真菌培养未发现病原体。患者无疼痛等自觉症状及刺激征。随访时３例视力在０．０５以上。结论玻璃体积血行玻璃体切除术后可能出现假性前房积脓，须与眼内感染相鉴别。     

白内障术后细菌性眼内炎的早期诊断和治疗

目的　探讨白内障术后细菌性眼内炎的早期诊断和治疗。方法　分析２０１２年８月至２０１３年２月期间本院及合作中心白内障超声乳化术后７例（７眼）细菌性眼内炎的临床表现、诊断和治疗以及预后情况。结果　６眼眼内炎早期表现不典型:仅有突发性前房炎症反映,而无眼痛、明显视力下降及充血、结膜水肿,无或仅有少量前房积脓、无玻璃体积脓,但１～２ｄ后眼内炎症快速发展:前房炎症反应加重、玻璃体出现积脓;１眼早期即有急剧视力下降、明显眼痛及前房、玻璃体积脓的典型表现。４眼经球内抗生素注射、３眼行玻璃体切割联合人工晶状体取出术后炎症控制。微生物培养结果（７眼）:２眼为表皮葡萄球菌,１眼为粪肠球菌,４眼阴性。随访视力均有提高,最高达０．５。结论　白内障术后出现突发性前房渗出性炎症,即便无眼痛及明显充血、视力下降者,仍需高度警惕细菌性眼内炎。早期诊断、及时治疗与病原学检查显得尤为重要,否则一旦炎症加重则错过最佳治疗时机、导致不可逆盲甚至眼球丧失。     

激光角膜共焦显微镜在真菌性眼内炎伴前房积脓诊断中应用

目的 对真菌性眼内炎伴前房积脓的患者,采用激光角膜共焦显微镜检查进行观察研究,并归纳总结其临床特点.方法 对11例(11只眼)真菌性眼内炎伴前房积脓的患者,其无明显角膜溃疡,角膜结构基本完整,早期进行激光角膜共焦显微镜检查,研究其图象特点.结果 文中真菌性眼内炎合并前房积脓的患者,采用激光角膜共焦显微镜能早期在角膜内皮面发现不同程度的真菌菌丝浸润.结论 激光角膜共焦显微镜可以无创的检查角膜各层,特别是角膜内皮面的细胞级结构,对于真菌性眼内炎伴前房积脓的患者,能够早期无创的检查角膜内皮面,比传统的侵人性检查能更早发现角膜内皮面的真菌菌丝,有利早期对该病进行诊断和治疗.     

外伤性眼内炎的研究进展

眼球穿破伤后可能发生感染性眼内炎合并症。眼内炎一旦发生,玻璃体腔内大量的炎症细胞浸润,伴随出现视力丧失、眼痛和前房积脓,进一步发展可导致全眼球炎、眼眶蜂窝织炎,不仅丧失视力,还常常丧失眼球,其严重性和危害性十分明显。现就其发病的危险因素、临床表现和临床处理等问题进行综述如下。     

手术联合两性霉素B脂质体治疗重症真菌性角膜溃疡

目的 观察手术联合两性霉素B脂质体治疗重症真菌性角膜溃疡的临床疗效.方法 选择经实验室、角膜共焦显微镜及眼B超确诊的氟康唑治疗无效的重症真菌性角膜溃疡患者64例(64只眼)(溃疡直径>5mm),其中合并前房积脓34例(34只眼),合并前房积脓继发青光眼18例(18只眼),合并前房积脓并发眼内炎12例(12只眼)(波及前1/2玻璃体9只眼,波及后部3只眼).应用两性霉素B脂质体全身及局部药物治疗,分别联合自体结膜瓣遮盖术、治疗性穿透性角膜移植、治疗性眼前段重建等手术治疗,观察其疗效.结果 行自体结膜瓣遮盖术16例;治疗性穿透性角膜移植39只眼;治疗性眼前段重建手术治疗9例.所有病例均同时进行两性霉素B脂质体前房冲洗,其中联合玻璃体注药7例.角膜溃疡、前房积脓34例中,无效3例;角膜溃疡、前房积脓并继发青光眼18例中,无效8例(其中3例治疗中途放弃);角膜溃疡、前房积脓并发眼内炎12例中,无效4例(其中2例治疗中途放弃).临床总有效率76.57%.结论 手术联合两性霉素B脂质体治疗重症真菌性角膜溃疡,取得了较好的临床疗效,可以缩短病程、挽救患者眼球,是治疗重症真菌性角膜溃疡的有效方法之一.同时强调真菌性角膜溃疡早期快速诊断是有效治疗的重要前提.     

玻璃体切割联合药物治疗球内异物致化脓性眼内炎疗效观察

目的 探讨球内异物致化脓性眼内炎的有效治疗途径。方法 对10例球内异物致化脓性眼内炎患者，作经睫状体平坦部玻璃体切割（PPV）＋球内异物取出术同时联合药物治疗（术中灌注液内加入抗生素），观察术后前房积脓、房水闪辉、B超、眼底、视力的变化情况。结果 所有患者术后前房积脓、房水闪辉、玻璃体混浊声像（B超）均消失，视网膜平伏，视力较术前提高。结 论PPV手术联合药物治疗是治疗球内异物致外伤性化脓性眼内炎的有效手段。     

白内障术后眼内炎的治疗分析

目的：探讨白内障术后眼内炎的治疗方案及效果。方法：对我院2006-01/2010-12白内障摘除术＋人工晶状体植入术的21973例28722眼患者的资料（超声乳化20937例27521眼,囊外摘除术1036例1201眼）进行回顾性分析。结果：在全部术眼中,感染性眼内炎11眼,感染率为0.04%,9眼发生于超声乳化术后,2眼发生于白内障囊外摘除术后。共有5眼病原菌培养阳性,其中表皮葡萄球菌2眼,金黄色葡萄球菌,浅绿色气球菌,真菌各1眼。感染发生于白内障术后2wk以内者占73%（8/11）,房水混浊或前房积脓者行前房灌洗＋玻璃体腔注射万古霉素;前房积脓合并明显玻璃体混浊或经前房灌洗＋玻璃体腔注射万古霉素治疗观察1～2d感染加重者行前房灌洗＋玻璃体切割术。治疗后11眼均保住眼球。结论：白内障术后眼内炎经常发生于白内障术后2wk以内,经及时有效的治疗可控制感染发展,保留部分有用视力;前房灌洗＋玻璃体腔注射万古霉素必要时联合玻璃体切割术是有效的治疗方法。     

角膜穿通伤术后缝线所致眼内炎四例

例1 男 26岁 22d前因左眼角膜穿通伤行角膜伤口缝合,术后早期伤口愈合良好.就诊时主诉左眼视力明显下降.检杏左眼视力眼前手动,中央角膜灰白溃疡,其间角膜缝线明显松动,溃疡表面白色坏死物附着,前房积脓2 mm,虹膜面脓性渗出覆盖,眼底无法窥入.B超提示,玻璃体混浊,角膜刮片发现真菌菌丝.诊断为左眼真菌性角膜溃疡,感染性眼内炎.     

非穿通伤引起的睫状体平部炎症

作者报导2例起初看来是非穿孔的轻微的外伤,在后期突然发生了眼内炎。其中一例明显地表现出色素膜-视网膜炎的特征。作者设想了构成眼内炎之病理生理,并与眼前节手术后突然发生的眼内炎的机制进行了比较。例1:9岁,女,被近距离内投掷的纸箭刺伤左眼。视力0.7.近角膜缘3点钟处有约1 mm大小之角膜伤口,伤口未贯穿。眼前节有前房纤维素渗出,瞳孔缩小,眼后极部轻微水肿。X线摄片未见球内异物。经治疗眼前段炎症好转。视力0.9,眼底正常。外伤后10天又具有眼内炎表现:前房积脓,玻璃体内弥散的粗大混浊致不能检查视网膜。经治疗24小时内前房积脓消失,玻璃体     

Recovery of Reliability by Retest After a 5-Minute Interval in Frequency Doubling Technology Perimetry

Purpose

In frequency doubling technology (FDT) perimetry, the incidence of tests classified as unreliable is higher in the second-tested left eye than in the first-tested right eye when perimetry is performed without a rest period. The purpose of this study was to determine whether the incidence of unreliable results was reduced when the retest began after a 5-min rest period.

Methods

The subjects were 978 residents of Miyoshi City, Japan, who underwent FDT perimetry during a medical checkup. FDT perimetry was always performed first on the right eye and then on the left eye without a rest interval. When the results were determined to be unreliable, FDT perimetry was repeated after a 5-min rest interval.

Results

The perimetric results were determined to be unreliable in one eye of 119 subjects; the results of the first-tested right eye were unreliable in 24 (20.2%), and the results of the second-tested left eye were unreliable in 95 (79.8%) subjects. This difference in the incidence of reliability was significant (P < 0.001). After a 5-min rest interval, the percentage of eyes with reliable results recovered to 92% of the right eyes and to 86% of the left eyes.

Conclusions

The incidence of unreliable results in FDT perimetry of the second-tested left eye was higher than that of the first-tested right eye when tests were performed without a rest interval. However, the incidence of unreliability in the eye was decreased when the retest was performed after a 5-min rest interval.?Jpn J Ophthalmol 2006;50:380–382 © Japanese Ophthalmological Society 2006     

A case of retained wooden foreign body in orbit

A 41-year-old man visited our clinic complaining of esodeviation of the right eye. He had been operated on for corneal laceration 3 years before. One month later, exodeviation of the right eye had developed. The result of computed tomography (CT) was reported as orbital abscess and cellulitis. Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve. On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect. Vision of the right eye was decreased to 0.02. Fundus examination showed optic atrophy. A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus. Although foreign body was surgically removed, vision and eye movement were not improved. In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed. On suspicion of a foreign body, imaging study such as CT or MRI must be performed. However, because CT findings can be variable, careful follow-up is needed.     

Nodular scleritis and Sweet's syndrome

The authors report a case of nodular scleritis in Sweet's syndrome. The patient was a 40-year-old Malay woman with a history of Sweet's syndrome presented with a 6-day history of a red and painful right eye associated with blurred vision. Clinical examination revealed nodular scleritis of the right eye which was deemed secondary to Sweet's syndrome after investigations for other systemic diseases were negative. The patient demonstrated good response to systemic corticosteroid therapy with complete resolution of scleritis in the right eye. However, her inflammatory skin condition worsened each time the systemic corticosteroids were tapered so colchicine and dapsone were added to treat the dermatologic disease. Ocular manifestations are uncommon in Sweet's syndrome but it is important to diagnose and treat them. This will prevent ocular morbidity and ensure a good clinical outcome.     

Posterior scleritis--diagnostic difficulties--a case report

We present a patient with pain and trouble vision in her right eye, we want to show how difficult it is to diagnose a posterior scleritis before any complication might occur. Diagnosis was established by ocular ultrasound. Treatment included steroids for several months.     

Orbital Involvement in Systemic Mastocytosis

Abstract

A 61-year-old female presented with a 3-day history of painful and reddened right eye with painful ocular movements. She had been diagnosed as having systemic mastocytosis 4 years earlier. Ocular examination showed Best Corrected Visual acuity of 6/6 right eye and 6/6 left eye. There was marked conjunctival injection and chemosis. The posterior segment was normal. The left eye was normal. Exophthalmometry showed 2?mm of right proptosis relative to the left eye. Computed tomography (CT) scans showed an ill-defined intra-conal lesion and enlargement of the lacrimal gland in the right orbit. A diagnostic biopsy was performed; the histopathology findings were of orbital mastocytosis. We present what our literature search suggests is the first biopsy-proven case of orbital mastocytosis.     

Anterior uveal and episcleral metastases from carcinoma of the breast

Breast carcinoma is the most common primary tumor producing intraocular metastasis. Metastases to the iris and ciliary body are relatively rare. The authors report a case of a 61-year-old lady, operated for carcinoma of the left breast 3 years back, who presented with symptoms and signs of acute narrow-angle glaucoma in the right eye. A diffuse whitish plaque-like mass in the upper nasal quadrant of the iris with an episcleral nodule on the limbus in the corresponding area and all the signs of acute narrow-angle glaucoma were present in the right eye. Intraocular pressure was controlled medically. Fine-needle aspiration cytology from the episcleral nodule showed malignant cells. Histopathology of the excised nodule showed metastatic poorly differentiated carcinoma, and the cellular pattern was similar to the carcinoma of the breast. There was no other metastasis anywhere in the body. Fine-needle aspiration cytology from an external lesion of the eye is a less invasive and easier procedure than paracentesis to diagnose the metastatic nature of the lesions. The rare features in our case are the clinical presentation as acute glaucoma and the ocular structures being the first and only site of metastasis.     

A case of central retinal artery occlusion after chiropractic manipulation of the neck

Here we report a case of central retinal artery occlusion after chiropractic manipulation on the neck. A 49-year old man presented at the hospital because of sudden visual loss in his right eye after chiropractic neck manipulation. He had received chiropractic manipulation of the neck by a chiropractor eight days prior. When he first visited us, his best corrected visual acuity in his right eye was hand motion. A full ophthalmic examination was performed. There was cherry-red spot in the macula in his right eye. We performed a fluorescein angiogram and cervical color Doppler. The arterio-venous transit time in the fluorescein angiogram was delayed, and we detected stenosis of the right internal carotid artery with diffuse atherosclerotic plaques in the right common carotid artery. We prescribed ginko biloba extract (Tanamin). Three years after his first visit, the best corrected visual acuity of his right eye was 20 / 200.     

A case of crystalline keratopathy in monoclonal gammopathy of undetermined significance (MGUS)

A 62-year-old female visited our clinic with progressively decreased vision in both eyes beginning 12 years prior. Idiopathic corneal opacity in all layers of the cornea was found in both eyes. One year later, we performed penetrating keratoplasty on the undiagnosed right eye. During post-surgical follow-up, corneal edema and stromal opacity recurred, and penetrating keratoplasty was performed two more times. The patient's total serum protein level, which had previously been normal, was elevated prior to the final surgery. She was diagnosed with monoclonal gammopathy of undetermined significance. We made a final diagnosis of monoclonal gammopathy-associated crystalline keratopathy after corneal biopsy. Monoclonal gammopathy-associated crystalline keratopathy is difficult to diagnose and may lead to severe visual loss. A systemic work-up, including serologic tests like serum protein or cholesterol levels, is needed in patients with unexplainable corneal opacity.     

Tectonic corneal graft for conjunctival rhinosporidiosis with scleral melt

A 16 year old girl presented with irritation and watering of the right eye for 3 months. On examination, the superior perilimbal sclera was ectatic with incarcerated uveal tissue covered by conjunctiva. The conjunctiva showed discreet, yellow white mucoid spots. Excision biopsy of the conjunctiva showed subepithelial spherules of sporangia containing numerous endospores, suggestive of rhinosporidiosis. Diathermy was applied to flatten the staphyloma. The ectatic area was covered with a corneal patch graft. The patient was started on prednisolone acetate eye drops and oral dapsone for 6 months. Corneal graft was well incorporated and conjunctivalized by 3 months. Since the graft was not seen within the palpebral aperture, there was good cosmetic result. The corneal graft had the added advantage of transparency which allowed visualization of the underlying tissue to diagnose early recurrence. There was no recurrence at 6 months.     

Direct residual stromal thickness measurement for assessing suitability for LASIK enhancement by Artemis 3D very high-frequency digital ultrasound arc scanning

We present a patient scheduled for LASIK enhancement based on conventional residual stromal thickness (RST) prediction methods in whom direct measurement of the RST changed the management due to an unexpectedly low RST. The preoperative refraction was -6.00 -0.50 x 115 in the right eye and -6.00 -0.50 x 20 in the left eye. At 9 months, the refractions had regressed to -0.50 -0.50 x 150 and -0.75 -0.25 x 145, respectively. Predicted RST based on preoperative parameters was 283 microm in the right eye and 281 microm in the left eye, sufficient for the planned enhancement. Using the Artemis 3-dimensional very high-frequency digital ultrasound arc scanner, the minimum RST was directly measured as 277 microm in the right eye but only 212 microm in the left eye, which may have significantly increased the risk of iatrogenic ectasia yielding a predicted post-enhancement RST of 253 microm and 192 microm, respectively. The treatment plan was altered as a result of the thinner than predicted RST in the left eye; an enhancement was performed in the right eye only. A second Artemis examination after 22 months found the RST in the left eye to be stable.