玻璃体切除术及药物治疗内源性真菌性眼内炎

目的 探讨内源性真菌性眼内炎的临床特点和治疗效果.方法 对近5年来经玻璃体切除术治疗和病原学诊断的内源性真菌性眼内炎5例（5眼）的临床资料进行回顾性分析.结果 5例采用玻璃体切除术联合全身抗真菌药物治疗,感染控制,手术后视力4例提高,1例下降.术中采取玻璃体标本真菌培养5例均为阳性.结论 内源性真菌性眼内炎起病隐匿,危害视力严重.及时采取玻璃体切除术联合全身抗真菌药物治疗有助于病原诊断和控制感染.     

白内障术后晚期无菌性眼内炎

无菌性眼内炎是白内障手术之一晚期合併症,其表现宛如细菌性眼内炎。典型症状是白内障术后经过良好,无合併症,且前玻璃体膜完整无损。但术后一至两个月,术眼突然疼痛、发红、视力减退及前房和玻璃体发生强烈反应等。此时发现前玻璃体膜已破裂,玻璃体粘连于手术伤口处。细菌及真菌培养皆为阴性。激素治疗效果良好。无菌性眼内炎之鉴别诊断包括细菌性眼内炎、真菌性限内炎、玻璃体束综合征(Vitreous Wick Syndrome)、术后慢性虹膜睫状体炎及Irvine-Gass综合征。细菌性眼内炎术后早期发生,细菌培养常为阳性,预后不佳,眼球可能丧失。真菌性眼内炎发生较晚,常有暂时性前房     

经玻璃体途径治疗真菌性眼内炎

经玻璃体途径治疗真菌性眼内炎董健鸿徐格致陈钦元关键词眼感染，真菌性／外科手术玻璃体切除术真菌性眼内炎的治疗一直是临床上的难题，常导致患者的视力丧失，眼球萎缩。由于玻璃体手术的开展，使这类疾病的预后得以明显改善。现将我们所遇到的真菌性眼内炎患者５例经玻...     

玻璃体切割治疗细菌性眼内炎的疗效观察

目的评估玻璃体切割治疗细菌性眼内炎的临床效果。方法收治22例细菌性眼内炎，抽吸前房水及玻璃体培养发现，常见的致病菌为葡萄球菌及枯草杆菌，采用玻璃体切割联合注药治疗眼内感染。结果治愈率为68％，总有效率为86％，3例丧失光感，占14％。结论玻璃体切割联合眼内注药是目前治疗眼内感染较为理想的方法。     

内源性真菌性眼内炎的临床特征和疗效分析

目的探讨内源性真菌性眼内炎的临床特征及其诊断和治疗方法。设计回顾性病例系列。研究对象2006—2009年北京同仁医院经玻璃体培养确诊为内源性真菌性眼内炎患者9例（13眼）。方法所有患者进行常规眼科检查,取前房水及玻璃体标本涂片和培养,4例进行血培养。给予局部及全身抗真菌药物治疗,行玻璃体注药（两性霉素B）或（和）玻璃体切除术。观察病变特点及治疗效果。主要指标视力,眼前节、服底表现,跟内液涂片及培养结果。结果男性2例,女性7例,4例双跟患病。平均年龄（38．33±15．49）岁。7例有明确发热史,自发热至出现眼部症状平均（26．43±24．81）天（2～60天）。无眼部外伤和内跟手术史。患者以视力下降、眼前黑影飘动遮挡为主诉。易感危险因素包括侵入性操作、免疫力低下等。临床可有或无典型前葡萄膜炎症表现,玻璃体炎性改变呈现团块状混浊,视网膜和（或）视网膜下黄白色浸润病灶。所有病例玻璃体真菌培养阳性。9／13眼玻璃体注药,10／13眼行玻璃体切除术。8例12眼随访（10．13±7．41）个月,11／12眼眼内炎得到控制,眼球保存,6／12眼视力提高。结论内源性真菌性眼内炎根据病史、危险因素、临床表现以及实验室检查等综合进行诊断。玻璃体切除术取材培养可提高检出率。玻璃体切除术及抗真菌药物治疗可有效控制感染,视力保持或提高。     

诊断性玻璃体手术临床应用及其微创化前景

诊断性玻璃体手术是对一些病因不明、治疗无效的眼内炎性疾病或恶性肿瘤等进行玻璃体手术,从而获得玻璃体和视网膜或脉络膜标本,再运用现代分子生物学技术和实验室技术进行明确诊断的一种手段.诊断性玻璃体手术可以明显提高临床医师对原因不明和传统方法治疗无效的非典型葡萄膜炎,可疑感染的眼内炎,进行性视网膜、脉络膜及色素上皮病变,伪装综合征及疑为恶性肿瘤的眼内出血的诊断率,可用于治疗慢性葡萄膜炎的并发症.诊断性玻璃体手术的微创化发展使手术更方便、更快捷、更安全.     

内源性眼内炎的临床特征及治疗

目的：探讨内源性眼内炎的临床特征及治疗。方法：对2005/2011年所收治的内源性眼内炎患者8例进行常规眼科检查,取前房水及玻璃体标本涂片和培养,血培养。给予局部及全身抗菌药物治疗,行玻璃体注药或（和）玻璃体切割术。观察病变特点及治疗效果。结果：患者8例9眼中男6例7眼,女2例2眼,年龄45～78岁。患者可有前葡萄膜炎症表现,玻璃体炎性改变,5例患者病原菌培养阳性,3眼行玻璃体腔注射,6眼行玻璃体切割手术。经治疗,患者病情控制,6眼视力提高。结论：内源性眼内炎根据病史、危险因素、临床表现以及实验室检查等综合进行诊断。局部＋全身治疗可有效控制感染。     

内源性真菌性眼内炎的临床特征及手术治疗

目的 分析内源性真菌性眼内炎的临床特征及手术治疗效果.方法 回顾性研究,分析6例（7眼）的临床特点和手术效果.结果 共6例（7眼）,均无眼外伤或内眼手术史,无全身侵入性操作史.本病的特点是易发生于老年、女性、糖尿病者、长期使用糖皮质激素者.早期临床表现与一般葡萄膜炎相似.3例（3眼）行眼球摘除术,1例（双眼患者）死亡,1例（1眼）行玻璃体切除术加玻璃体腔注射抗真菌药物,保存了部分视功能,1例失访.结论 内源性真菌性眼内炎根据病史、临床表现及实验室检查可以确诊并且与一般葡萄膜炎相鉴别,早期施行玻璃体切除加玻璃体腔抗真菌药物注射可以保存部分视功能.     

外因性眼内炎的疗效评价

目的 评价外因性眼内炎的治疗效果。方法 回顾性总结26例26眼由眼球穿孔伤及白内障手术所致外因性眼内炎的治疗结果。治疗方法有玻璃体腔注药及玻璃体切除术。结果 随访4—32月，平均7月，26眼中25眼(96．2％)炎症得到控制，22眼(84．6％)视网膜在位。视力提高20眼(76．9％)，不变3眼(11．5％)，下降3眼(11．5％)。玻璃体切除术后发生视网膜脱离7眼，4眼再次行玻璃体手术后视网膜复位。结论 玻璃体腔注药和玻璃体切除术是治疗外因性眼内炎的有效方法；根据病情变化的需要，及时行玻璃体切除术十分重要。     

内源性真菌性眼内炎的临床分析

目的:分析内源性真菌性眼内炎的临床特征及误诊原因。方法:3例患者根据病情、病史进行了眼科常规检查及实验室有关检查,确诊后进行药物治疗,其中1例进行手术治疗。结果:3例均存在内源性真菌性眼内炎感染诱因。2例患者误诊为葡萄膜炎,1例患者误诊为视网膜脉络膜炎。2例通过早期积极治疗后,视力均有不同程度的提高。结论:内源性真菌性眼内炎发病隐匿,进展缓慢,非常容易被忽视并误诊,详细询问病史和合理的检查对其诊断有着重要的帮助。早期积极有效的治疗,可以高治愈率和保存视功能。     

Diagnostic vitreous biopsy in patients with uveitis: a useful investigation?

PURPOSE: To assess whether the results of microbial and cytological investigations of vitreous biopsy specimens are useful in the management of patients with intraocular inflammation. METHOD: A retrospective review of the medical records of 59 consecutive patients from consulting rooms, outpatient clinics and inpatient consultation who underwent intravitreal sampling between January 1997 and December 2003. Results of the biopsies were examined to determine if they altered management of the patient. RESULTS: The clinical diagnosis was correct in 37 of 59 patients (62.7%) with ocular inflammation. The organism was identified in 50% (7/14) of vitreous biopsies in patients with postoperative endophthalmitis. Of patients with endogenous bacterial endophthalmitis 16.7% (1/6) had the diagnosis confirmed by vitreous tap and 83.3% (5/6) had positive cultures from other sites that provided the diagnosis. Of the fungal endophthalmitis 80% (4/5) grew the fungus from the vitreous biopsy. Viral polymerase chain reaction identified the causative organism in 87.5% (7/8) of patients with clinical diagnosis of viral infection. 30.8% (4/13) vitreous biopsies in patients with clinically suspected masquerade syndromes were diagnosed as lymphoma. Vitreous biopsy results altered management significantly in seven (11.9%) patients. These patients included toxoplasmosis that was thought to be viral retinitis; malignant melanoma thought to be fungal endophthalmitis; chronic inflammation secondary to retinal detachment that was thought to be a neoplasm; three patients with infective endophthalmitis thought to be idiopathic uveitis and a patient with known lung carcinoma thought to have metastases who had lymphoma. In 67.8% (40/59) the vitreous sample helped to either confirm the diagnosis or exclude an infective cause. Complications from vitrectomy were hypotony (1/29) and retinal detachment (1/29). CONCLUSION: Clinical diagnosis based on examination findings and vitreous biopsy is highly accurate. Vitreous sampling altered the management of seven of 59 patients. Vitreous biopsy is a safe and useful method for diagnosing and excluding malignancy and infection in patients with ocular inflammation. Viral polymerase chain reaction is highly sensitive and accurate. The sensitivity of microbiological culture techniques for bacteria and fungi limits their usefulness.     

Novel diagnosis of fungal endophthalmitis by broad-range real-time PCR detection of fungal 28S ribosomal DNA

Aim

To detect the fungal genome in the ocular fluids of patients with fungal endophthalmitis by using a novel broad-range polymerase chain reaction (PCR) system.

Methods

After informed consent was obtained, ocular fluid samples (aqueous humor or vitreous fluids) were collected from 497 patients (76 patients with infectious endophthalmitis including clinically suspected bacterial and fungal endophthalmitis and 421 patients with infectious or non-infectious uveitis). Forty ocular samples from non-infectious patients without ocular inflammation were collected as controls. Fungal ribosomal DNA (28?S rDNA) was measured by a quantitative real-time PCR assay.

Results

Fungal 28?S rDNA of the major fungal species, such as Candida, Aspergillus, and Cryptococcus, were detected by novel broad-range real-time PCR examination (>10¹ copies/ml). Fungal 28?S rDNA was detected in the ocular fluids of 11 patients with endophthalmitis or uveitis (11/497, 2.2%). All 11 positive samples were detected in the infectious endophthalmitis patients (11/76, 14.5%). These PCR-positive ocular fluids had high copy numbers of fungal 28?S rDNA (range, 1.7 × 10³ to 7.9 × 10⁶ copies/ml), which indicated the presence of fungal infection. Of the 11 patients who were PCR positive, further examinations led to a diagnosis of fungal endophthalmitis in ten patients. The fungal 28?S rDNA was detected in one non-infectious case (a false-positive case). In addition, there were two PCR false-negative cases that were clinically suspected of having fungal endophthalmitis.

Conclusions

This novel quantitative broad-range PCR of fungal 28?S rDNA is a useful tool for diagnosing endophthalmitis related to fungal infections.     

Diagnostic Utility of Quantitative Polymerase Chain Reaction versus Culture in Endophthalmitis and Uveitis

Purpose: To compare genetic testing for microbes in infectious endophthalmitis or uveitis to culture.Methods: This was a retrospective, single-center case series that enrolled patients with clinically suspected endophthalmitis or uveitis of unknown etiology. Aqueous humor or vitreous was collected and sent for routine cultures and genetic testing.Results: In total, 46 patients were enrolled. Genetic testing was positive in 32/46 (70%) cases and culture 6/46 cases (13%). Five of 16 uveitis cases had a final clinical diagnosis of infectious uveitis, and polymerase chain reaction (PCR) was positive in 4/5 cases (80%), versus 0% for culture. In uveitis cases, PCR was 80% sensitive and 82% specific, and culture had 0% sensitivity. The overall sensitivity and specificity of PCR for all cases were 85% and 67%, respectively, compared with 17% and 100% for culture.Conclusion: Genetic assays are inexpensive ($25/case) and more sensitive than culture for identifying intraocular pathogens in endophthalmitis and uveitis.     

Incidence of presumed postoperative endophthalmitis in Dublin for a 5-year period (1997--2001)

PURPOSE: To evaluate the incidence of presumed endophthalmitis following cataract surgery over a 5-year period in a busy ophthalmic hospital. SETTING: Ophthalmology unit in the Royal Victoria Eye and Ear Hospital, Dublin, Ireland. METHODS: A retrospective series of 8736 consecutive cases of cataract extraction with intraocular lens implantation carried out during a period of 5 years from 1997 to 2001 were studied. All cases requiring readmission due to suspected postoperative infection were investigated as part of the study. RESULTS: A total of 8763 patients had a cataract procedure. Forty three of them were readmitted with suspected endophthalmitis, giving a total suspected endophthalmitis rate of 0.5%. Of the 43 readmitted cases, 29 cases (67%) had hypopyon and 14 cases (32%) had fibrinous uveitis. Of those with hypopyon, 83% received intravitreal antibiotics. Of those with fibrinous uveitis, none received intravitreal antibiotics. There was a difference in the numbers achieving visual acuity of 6/12 or better between the 2 groups (33% and 14% of patients, respectively). In cases that had a vitreous biopsy, 10 (42%) were culture positive and of these, the most common organism found was Staphylococcus aureus (50%). Fourteen of the 43 cases (32.5%) that presented with fibrinous uveitis were treated with topical, subconjunctival, and systemic antibiotics with steroids. Visual acuity of 6/12 or better was achieved in 6 patients (14%). CONCLUSIONS: The incidence of suspected endophthalmitis following cataract surgery in a 5-year period in a busy Irish ophthalmic unit was 0.49%. Culture-positive endophthalmitis was 0.1%, but only 56% of cases with presumed endophthalmitis had a vitreous biopsy performed. The visual outcome was better in patients who were treated with intravitreal antibiotics at the first sign of symptoms. These findings support the hypothesis that infection is the most likely cause of postoperative endophthalmitis and that it may present as hypopyon or fibrinous uveitis. Prompt investigation and treatment of such patients with a standard endophthalmitis protocol should be instituted to save vision.     

Diagnostic testing of vitrectomy specimens

PURPOSE: To assess the usefulness of diagnostic tests that are performed on vitrectomy specimens from patients with suspected lymphoma or infection. DESIGN: Noncomparative, retrospective, interventional case series. METHODS: Seventy-eight consecutive patients (84 eyes) underwent pars plana vitrectomy for diagnostic purposes. Vitrectomy with cytologic, cytofluorographic, or microbiologic analysis of vitreous samples was performed. The main outcome measures were the efficiency of diagnostic procedure and positive and negative predictive values (PPV and NPV). RESULTS: There were 28 patients (33 eyes) with suspected intraocular lymphoma and 50 patients (51 eyes) with suspected infection, which was subdivided into chronic endogenous endophthalmitis, atypical chorioretinitis, or chronic postoperative inflammation. Vitreous testing led to a diagnosis in 48 of 78 patients (61.5%); 14 patients with a final diagnosis of lymphoma/leukemia, and 34 patients with a final diagnosis of infection. When preoperative indication was compared with final clinical diagnosis, the efficiency of the diagnostic procedure of cytologic evaluation, flow cytometry, and bacterial/fungal culture was 67%, 79%, and 96%, respectively. For lymphoma, the PPV of cytologic evaluation was 100% and the NPV 60.9%. For infection, the PPV of bacterial/fungal culture was 100% and the NPV 94.9%. CD22+ B lymphocytes >or=20% of total cells on cytofluorographic analysis had a PPV of 88% for lymphoma. A cytofluorographic CD4:CD8 T-lymphocyte ratio >or=4 had a PPV of 70% for immunologically mediated uveitis. Surgical complications were rare and manageable. CONCLUSION: Diagnostic vitrectomy in selected patients with carefully planned testing is an effective means of supporting diagnoses in intraocular lymphoma, chronic intraocular infections, and atypical chorioretinitis. Flow cytometry quantitates the percentages and ratios of various cell types and is helpful in contrasting intraocular lymphoma with immunologically mediated uveitis.     

眼外伤所致尖端赛多孢菌性眼内炎

目的 探讨眼外伤所致尖端赛多孢菌性眼内炎的临床特点和治疗方法.方法 回顾分析我院2003年至2008年经玻璃体培养证实为尖端赛多孢菌的眼内炎12例（12眼）,分析其发病原因、临床表现、治疗经过及治疗结果.结果 患者入院后均急诊行玻璃体切除术,并口服伊曲康唑.玻璃体标本细菌培养结果为尖端赛多孢菌.11例感染控制后出院,随访视力无光感1例,手动～数指8例,0.1～0.3者2例,随访期无复发.1例术后感染不能控制,行眼内容物摘除术,术后角膜病检提示为真菌性角膜溃疡.结论 尖端赛多孢菌是一种新出现的侵袭性真菌感染的病原菌,眼科临床工作者应提高对该病的认识.