膀胱癌感染引起转移性眼内炎1例

1临床资料患者，男，52a，因右眼痛，红，视力下降3d入院（右眼曾于3a前在我院行滤过性抗青光眼术，左眼曾于sa前在他院行滤过性抗青光眼术）。检查：视力右眼光感，左眼无光感，右眼球结膜混合性充血，12．点位有一不典型滤泡，房水絮状渗出，瞳孔4mm，玻璃体呈黄光反射。血常规：白细胞12．8×1012／L中性84．4％，尿中可见较多红白细胞，同时伴有展急、尿频、尿痛。立即给予全身、局部抗生素、激素治疗sd后前房内炎症吸收、但玻璃体仍残留大量人黄色絮状、片状混浊物。治疗d10，玻璃体内炎症亦明显吸收，眼底能窥见，视力提高至0．8．因…     

混合性转移性眼内炎一例

患者女，24岁。3个多月前因面部长红斑在当地诊断为“红斑狼疮”，静脉给药头孢噻肟钠8～10g／d、头孢曲松钠6～10g／d、克林霉素1．2～2．4g／d、培氟沙星0．2g／d、氧氟沙星0．2g／d、地塞米松10mg／d、环磷酰胺200mg／d等治疗，长达3个月。10多天前，右眼前出现飞蚊、红痛伴视力下降，当地另一医院诊断为“右眼虹膜睫状体炎”，又给予静脉滴注先锋霉素、     

腹部手术致双眼转移性眼内炎二例

腹部手术致双眼转移性眼内炎二例谢盛绪例１女，２８岁，因持续右下腹疼痛，诊断为“阑尾炎”。于１９８９年４月２９日行阑尾切除手术，术中见阑尾正常，右卵巢破裂，裂口处有渗血，腹腔内有约１０００ｍｌ陈旧性血液。行卵巢包埋缝合，清除积血。手术后４８小时，出现高...     

转移性眼内炎致眼内容摘除一例

患者 ,女 ,6 9岁。因肝脓肿住内科治疗。次日诉右眼球后痛 ,请眼科会诊。右眼球结膜充血 ( +) ,角膜透明 ,前房清 ,眼球活动好 ,眼底未查。拟右眼疼痛加剧 ,再次眼科会诊。右眼无光感 ,眼球轻度突出 ,活动轻度受限 ,球结膜混合充血 ( ++) ,角膜透明 ,瞳孔区可见黄色渗出膜 ,眼底窥不见 ,拟诊眼内炎。治疗 :在内科静脉大剂量联用有效抗生素的基础上 ,局部庆大霉素 2万ｕ加地塞米松 5ｍｇ球旁注射 ,每日 1次 ,阿托品散瞳 ,每日 3次 ,点必舒及氧氟沙星滴眼液滴眼 ,每日 4次 ,2周后随访 ,眼压38ｍｍＨｇ( 1ｍｍＨｇ =0 .133ｋＰａ)球结膜混合允…     

临床细菌性眼内炎的病原学分析

目的探讨细菌性眼内炎致病菌的菌属分布及其药物敏感性,为临床诊断与治疗提供依据。方法对1999年1月至2006年12月北京同仁眼科中心临床送检的728份房水和玻璃体标本,进行常规细菌培养鉴定和纸片扩散法药物敏感性试验;对培养阳性菌株的菌属分布及其药物敏感性进行回顾性分析。结果728份房水和玻璃体标本中,细菌培养阳性标本160份,平均培养阳性率为22．0％;共培养出168株细菌,其中革兰阳性球菌96株（57．1％）,革兰阳性杆菌18株（10．7％）,革兰阴性球菌2株（1．2％）,革兰阴性杆菌52株（31．0％）。主要分离菌为表皮葡萄球菌36株（21．4％）,金黄色葡萄球菌19株（11．3％）,铜绿假单胞菌15株（8、9％）。革兰阳性球菌对万古霉素敏感率为93．4％（85／91）、对左旋氧氟沙星为84．4％（81／96）,革兰阴性杆菌对左旋氧氟沙星敏感率为88．2％（45／51）、对氧氟沙星为76．9％（40／52）、对环丙沙星为75．0％（39／52）。前4年（1999年至2002年）与后4年（2003年至2006年）主要致病菌药物敏感性比较,结果发现常用药物的敏感性均有不同程度的下降。结论细菌性眼内炎致病菌谱较广,临床常用抗菌药单一使用时常不能有效覆盖主要致病菌,因此治疗时应考虑联合用药。     

白内障术后细菌性眼内炎的研究进展

本文就白内障术后细菌性眼内炎致病菌对人工晶状体的粘附性与术后眼内炎的关系,抑制其粘附性的方法,以及对致病菌来源的追踪进行综述。     

转移性眼内炎致双眼相继突发失明一例

转移性眼内炎起病急 ,发展快 ,早期有时原发病灶症状不典型 ,易漏诊误诊原发病 ,若以眼科表现为主诉 ,更易造成漏诊误诊而致突发失明。转移性眼内炎致双眼失明者极其少见 ,现将我院所见 1例报告如下。患者 ,女 ,72岁 ,因双眼相继突发失明、剧烈眼痛、头痛、高热、寒战 2天来我院眼科就诊。复习病史 ,患者 5天前因持续高热、寒战、间歇腹痛 3天 ,到某院内科就诊 ,未明确诊断 ,拟诊“发热待查” ,给予青霉素 80 0万Ｕ、地塞米松 10ｍｇ静滴 ,稍有好转 ,体温下降 ,寒战消失 ,腹痛不明确。 3天后 ,感右眼疼痛 ,又到眼科就诊 ,诊断为急性虹膜睫状…     

Systematic review of 342 cases of endogenous bacterial endophthalmitis

We review a total of 342 cases of endogenous bacterial endophthalmitis reported between 1986 and 2012. Predisposing conditions were present in 60%, most commonly diabetes, intravenous drug use, and malignancy. The most common sources of infection were liver, lung, endocardium, urinary tract, and meninges. Systemic features such as fever were present in 74%, hypopyon in 35%, and an absent fundal view in 40%. Diagnostic delay occurred in 26%. Blood cultures were positive in 56%, and at least one intraocular sample was positive in 58% (comprising 26% anterior chamber samples, 59% vitreous taps, and 41% vitrectomy specimens). Worldwide, Gram negative infections (55%) were more frequent than Gram positive (45%) infections, particularly in Asia. Over the last decade, 11% of eyes were treated with systemic antibiotics alone, 10% intravitreal antibiotics alone, 36% systemic plus intravitreal antibiotics, and 20% systemic plus intravitreal antibiotics plus pars plana vitrectomy. The most commonly used intravitreal antibiotics were vancomycin (for Gram positive infection) and ceftazidime (Gram negative). The median final visual acuity was 20/100, with 44% worse than 20/200. Among all cases, 24% required evisceration or enucleation, and mortality was 4%. Both intravitreal dexamethasone and vitrectomy were each associated with a significantly greater chance of retaining 20/200 or better and significantly fewer eviscerations or enucleations—these warrant further study. For most patients, treatment should include a thorough systemic evaluation and prompt intravitreal and systemic antibiotics.     

Polymerase chain reaction in the diagnosis of bacterial endophthalmitis

BACKGROUND—Microbiological investigations of vitreous fluid (VF) and aqueous humour (AH) specimens have often failed to detect the infecting agent in infectious endophthalmitis, resulting in a clinical dilemma regarding therapy. In this study, the polymerase chain reaction (PCR) was evaluated in the diagnosis of bacterial and Propionibacterium acnes endophthalmitis.
METHODS—58 intraocular specimens (30 VF and 28 AH) from 55 cases of endophthalmitis and 20 specimens (14 VF and 6 AH) as controls from non-infective disorders were processed for microbiological investigations. Nested PCR directed at the 16S rDNA using universal primers for eubacterial genome was done. PCR for P acnes was performed on specimens microbiologically negative by conventional techniques but eubacterial genome positive.
RESULTS—Of the 20 controls from non-infective cases, one (5%) was positive using eubacterial primers and none with P acnes primers. PCR for eubacterial genome showed 100% correlation with 20 (34.5%) bacteriologically positive specimens. Eubacterial genome, was detected in 17 (44.7%) of 38 bacteriologically negative specimens and nine (52.9%) out of the 17 were positive for P acnes genome. Among the 21 eubacterial PCR negative specimens, seven were fungus positive. By inclusion of PCR, microbiologically positive specimens increased from 46.5% to 75.8%. PCR on AH was as sensitive as that on VF for the detection of both eubacterial and the P acnes genome.
CONCLUSION—PCR performed on AH and VF is a reliable tool for the diagnosis of bacterial and P acnes endophthalmitis particularly in smear and culture negative specimens.

Keywords: polymerase chain reaction; bacterial endophthalmitis; infectious endophthalmitis     

Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases

Endogenous bacterial endophthalmitis is a rare but serious condition that occurs when bacteria cross the blood-ocular barrier and multiply within the eye. We provide an overview of endogenous bacterial endophthalmitis by reviewing 267 reported cases and integrating this with our experience of an additional 19 cases. The majority of patients with endogenous bacterial endophthalmitis are initially misdiagnosed and many have an underlying disease known to predispose to infection. This condition is often previously undiagnosed. Blood cultures are the most frequent means of establishing the diagnosis. The most common Gram positive organisms are Staphylococcus aureus, group B streptococci, Streptococcus pneumoniae,and Listeria monocytogenes.The most common Gram negative organisms are Klebsiella spp., Escherichia coli, Pseudomonas aeruginosa, and Neisseria meningitidis. Gram negative organisms are responsible for the majority of cases reported from East Asian hospitals, but Gram positive organisms are more common in North America and Europe. The visual outcome is poor with most cases leading to blindness in the affected eye. Many patients have extraocular foci of infection, with an associated mortality rate of 5%. The outcome of endogenous bacterial endophthalmitis has not improved in 55 years and clinicians need to have a high level of awareness of this commonly misdiagnosed condition.     

盐酸万古霉素综合方案治疗眼内炎

目的：探讨盐酸万古霉素综合方案治疗眼内炎的临床疗效和并发症。 方法：收集我院2009-07/2011-08眼内炎住院患者27例27眼,采用盐酸万古霉素综合治疗方案进行治疗。所有患者取玻璃体做细菌培养和药敏试验。采用玻璃体腔内注射盐酸万古霉素,全身使用盐酸万古霉素联合左旋氧氟沙星。炎症无明显好转者,2~4d后行玻璃体切割术,术中使用含盐酸万古霉素的灌注液。术后观察视力、眼压、前房和玻璃体混浊情况。对术后最佳矫正视力和眼压进行统计学分析。 结果：患者27例眼内炎均治愈,视力均有提高。细菌培养检出率56%。革兰氏阳性菌占67%,对盐酸万古霉素敏感。革兰氏阴性菌对氧氟沙星较敏感。8例患者经过静脉滴注及玻璃体腔内注药后眼内炎症控制,19例行玻璃体切割手术。术后最佳矫正视力提高。临床症状体征好转。 结论：早期细菌培养对眼内炎的治疗有重要意义。盐酸万古霉素综合治疗方案能有效治疗眼内炎。     

强化妥布霉素滴眼液在外因性细菌性眼内炎治疗中的应用

目的：探讨强化妥布霉素滴眼液治疗急性外因性细菌性眼内炎的方法和疗效.方法：54例随机分成两组,每组27例（27眼）.强化治疗组（A组）：13.4g/L妥布霉素滴眼液滴眼;对照组（B组）3g/L妥布霉素滴眼液滴眼.两组均进行前房冲洗加前房注射万古霉素,辅以全身加局部同种和相同剂量的抗生素及激素治疗.分别观察两组房水渗出全部吸收平均时间、角膜水肿完全消退平均时间、房水病原菌培养结果和术后1mo最佳矫正视力,统计学处理采用t检验.结果：两组病例眼内炎症均得到控制,大部分视力得到不同程度改善.强化治疗组房水纤维素性渗出吸收时间短于对照组,统计学分析有显著性差异.两组房水病原菌培养结果和术后1mo最佳矫正视力分布差异没有统计学意义.结论：对于急性外因性细菌性眼内炎,在及时前房冲洗、前房注药治疗或者联合玻璃体切割术之外,13.4g/L强化妥布霉素滴眼液频繁滴眼有利于眼内炎症控制,是有效而且安全的辅助治疗方法.     

Etiology and diagnosis of bacterial postoperative endophthalmitis.

It is necessary to determine if postoperative endophthalmitis is of infectious or sterile etiology. Intraocular contents should be cultured and were positive in 50% of 58 eyes tested at our institute with suspected postoperative endophthalmitis. The vitreous aspirate is more sensitive than the anterior chamber aspirate in making a diagnosis. The use of a membrane filter to concentrate vitreous samples obtained at vitrectomy increases diagnostic yield. Fifty percent of culture-positive eyes yielded gram-positive organisms. Stained smears were consistent with the cultured organism in half of the cases.     

Microbial profile and antibiotic susceptibility of culture-positive bacterial endophthalmitis

Purpose

To assess the distribution of microorganisms isolated from patients with bacterial endophthalmitis and their antimicrobial susceptibility.

Methods

Retrospective analysis of medical and microbiological records of patients with suspected diagnosis of endophthalmitis. The following information was assessed: number of presumed and culture-positive endophthalmitis cases, source of infection, microbiological result (aqueous and/or vitreous culture and Gram staining), microbial characterization and distribution, and antimicrobial susceptibility.

Results

A total of 107 (46%) of 231 patients with bacterial endophthalmitis showed positive results by gram stain or culture. Of these, 97 (42%) patients were positive for culture only. Most of them (62%) were secondary to a surgical procedure (postoperative), 12% were posttraumatic and 26% were secondary to an unknown source or the data were unavailable. A total of 100 microorganisms were isolated (38 aqueous and 67 vitreous samples) from the 97 culture-positive cases (91% were gram-positive and 9% were gram-negative). Coagulase-negative Staphylococcus(CoNS) (48%) were the most frequently isolated, followed by Stretococcus viridans(18%), and Staphylococcus aureus(13%). The antimicrobial susceptibility for CoNS was as follows: amikacin—91.6%, cephalothin—97.9%, ceftriaxone—50%, ciprofloxacin—62.5%, chloramphenicol—91.8%, gatifloxacin—79.5%, gentamicin—72.9%, moxifloxacin—89.5%, ofloxacin—70.8%, oxacillin—58.3%, penicillin—33.3%, tobramycin—85.4%, and vancomycin—100%.

Conclusion

Gram-positive bacteria were the major causes of infectious endophthalmitis in this large series, usually following surgery. CoNS was the most common isolate. Of interest, susceptibility to oxacillin and fourth-generation quinolones was lower than previously published.     

细菌性眼内炎的免疫赦免及免疫应答机制

细菌性眼内炎是能导致视力严重受损的眼科重症,即使采取了及时和积极的药物及手术干预,仍会造成眼部组织不可逆的损伤.对细菌性眼内炎的研究热点是研究眼部组织对感染的免疫反应及病原微生物和宿主组织间分子和细胞的相互作用.目前国内外对细菌性眼内炎免疫应答机制的研究包括免疫赦免、固有免疫反应、补体系统、Fas配体、炎性细胞浸润、细胞因子及细胞间黏附因子的作用等方面.     

Management of bacterial postoperative endophthalmitis and the role of vitrectomy

Management of postoperative bacterial endophthalmitis was explored in the Endophthalmitis Vitrectomy Study³⁷ in 1995, which has underpinned the core protocols in treatment ever since. While surgical techniques have continued to evolve, little has changed in the overall clinical management as no further large randomized controlled trials have taken place. We review the literature addressing the incidence of endophthalmitis, pathogens, antibiotic therapies, and the role of vitrectomy. We suggest an update to management protocols based on available evidence. While vitreous culture remains the gold standard for diagnosis, new techniques allow bacterial identification after antibiotic administration, so injection should be initiated immediately. Current antibiotic regimes are comprehensive and do not need changing. Intravitreal antibiotics should not be repeated at 48 hours after initial treatment. Vitrectomy should be considered instead if the clinical picture is not improving.     

眼内炎16例临床分析

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2010-01/2012-12收治的眼内炎患者共16例16眼进行回顾性分析,其中男13例,女3例,年龄42～82(平均60)岁。其中5例患者行眼球内容物剜除术,11例患者行玻璃体切割术。结果:因眼外伤所致眼内炎8例,内源性眼内炎2例,白内障术后2例,抗青光眼术后2例,感染性角膜炎1例,白内障过熟期晶状体过敏性眼内炎1例。经玻璃体切割术后8例视力有不同程度提高,脱盲(视力>0.05)6例(55%)。结论:眼外伤是眼内炎的最常见原因,玻璃体切割手术治疗能不同程度恢复患者视功能。