儿童外伤性眼内炎的临床疗效分析

目的:探讨儿童外伤性眼内炎的治疗效果.方法:回顾性研究2 ～11岁儿童确诊为外伤性眼内炎24例24眼的治疗方法及结果.所有患儿入院后立即行患眼的玻璃体腔内注药(万古霉素1mg/0.1mL+头孢他啶2.25mg/0.1mL+地塞米松0.4 mg/0.1 mL),第2d,23例重症者行玻璃体切除+晶状体切除术,充填硅油者10例、无菌空气者8例、C3F8者3例、灌注液者2例.1例轻症者72h后再次注射.结果:术后随访6 ～ 78mo,所有病例炎症控制,4例眼球萎缩(3例硅油眼).7例硅油眼已取出硅油并植入IOL.BCVA:＜0.02者12例,0.02～0.1者4例,0.15 ～0.3者4例,0.5 ～1.0者4例.16例(70％)较入院视力提高,4例(17％)不变,3例(13％)下降,1例不配合.结论:及时行玻璃体腔内注射广谱抗生素、玻璃体切除术能改善儿童外伤性眼内炎的预后.     

A lack of ongoing diabetes is an important factor in preserving eyes from late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess

Purpose:

The purpose of this study is to identify the possible factors for preserving the eyes after late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.

Methods:

A retrospective chart review was conducted for patients admitted with KP liver abscess from January 1991 to June 2012.

Results:

Six hundred and ninety-three patients with KP liver abscess were recorded, in which endophthalmitis was identified in 53 cases (65 eyes, 8.29%). Diabetes was significantly associated with the development of endophthalmitis (p = 0.014). Eleven eyes received their last ocular treatment ≥10 days and final vision ≥ counting fingers, and were defined as benign type KP endophthalmitis. The absence of diabetes was the only consistent candidate factor for benign type KP endophthalmitis.

Conclusion:

A lack of ongoing diabetes is an important factor in preserving eyes with late or suboptimally treated endogenous endophthalmitis second to KP liver abscess.     

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.     

Incidence of cystoid macular oedema with intracameral cephalosporin or vancomycin in cataract surgery

Abstract

Purpose: To compare the incidence of pseudophakic cystoid macular oedema (CME) in patients who receive intracameral cephalosporin versus intracameral vancomycin during cataract surgery.

Methods: A retrospective chart review was conducted on subjects with the diagnosis of CME between January 1 2010 and July 31 2017. Inclusion criterion was the documentation of CME after cataract extraction. Exclusion criteria were intraoperative complication, prior history of macular oedema, epiretinal membrane, uveitis, other pre-existing retinal pathology, or other post-operative pathology including other ocular surgery in the post-operative period.

Results: The final analysis included 89 eyes with optical coherence tomography (OCT) proven CME. The incidence of pseudophakic CME in our population of 10,165 cataract surgeries after applying the above-stated exclusion criteria was 0.88%. The incidence of pseudophakic CME in subjects who received intracameral cephalosporin was 0.87% (mean age in years 69?±?11; 31 male [39%], 48 female [61%]). The incidence of pseudophakic CME in subjects who received intracameral vancomycin was 0.96% (mean age in years 66?±?13; 4 male [40%], 6 female [60%]). Pearson’s chi-square test demonstrated no significant difference between these groups (p?=?0.7705).

Conclusions: There was no statistical difference in the incidence of pseudophakic CME in subjects who received intracameral cephalosporin versus intracameral vancomycin during cataract surgery.     

感染性眼内炎患者玻璃体液中坏死性凋亡相关蛋白 MCP-1的检测

目的：探讨感染性眼内炎患者玻璃体液中坏死性凋亡相关蛋白 MCP-1的表达及其与视力预后的关系,为预测疾病预后及进一步的眼内药物干预,保护视功能提供实验室依据。方法收集17例感染性眼内炎患者的玻璃体液,检测坏死性凋亡相关蛋白单核细胞趋化蛋白1(MCP-1)的表达,分析临床治疗效果。结果实验组感染性眼内炎患者玻璃体液中 MCP-1的浓度显著高于对照组 MCP-1的浓度(P <0．05);实验组的 MCP-1浓度与最佳矫正视力呈负相关性(P<0.05)。结论感染性眼内炎患者眼内有坏死性凋亡的发生,与患者视功能损害有关,这为进一步干预坏死性凋亡,保护患者视功能提供了依据。     

灌注液中庆大霉素对白内障患者结膜囊细菌的作用

目的:分析白内障手术灌注液中庆大霉素对白内障患者结膜囊细菌的作用,为制定围手术期眼内炎预防措施提供依据。方法:采集200例白内障患者结膜囊拭子标本,进行细菌培养鉴定和药物敏感试验,观察检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率。结果:结膜囊细菌培养阳性检出率为62%,其中以表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为3.22%,耐甲氧西林表皮葡萄球菌（MRSE）检出率为28.2%;全部检出细菌对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为79.84%、95.16%、97.58%、78.23%,中高浓度庆大霉素和左氧氟沙星比较,差异有统计学意义（均P<0.05）;MRSA和MRSE对20 μg/mL、40 μg/mL、80 μg/mL庆大霉素和2 μg/mL左氧氟沙星敏感率分别为69.23%、94.87%、100%、41.03%,各浓度庆大霉素和左氧氟沙星比较,差异有统计学意义（均P<0.05）。结论:白内障患者结膜囊细菌对灌注液中庆大霉素具有较高的敏感度,灌注液中加入适宜浓度庆大霉素,作为白内障围手术期眼内炎预防的措施应继续加以推广。     

Retinal manifestations in patients following COVID-19 infection: A consecutive case series

Purpose:To describe retinal manifestations seen in patients associated with COVID-19 infection at a multi-specialty tertiary care hospital in Southern India.Methods:In this retrospective chart review, all consecutive cases presenting to the Retina-Uveitis service from May 2020 to January 2021 with retinal manifestations associated with COVID-19 infection or its sequelae or as a result of treatment given for COVID-19 were included.Results:Of the 7 patients, 3 were female, and 4 were male. Four patients had onset of symptoms during the active phase of COVID-19 infection. Four had bilateral and three had unilateral involvement. The manifestations ranged from mild to vision threatening. Vision threatening manifestations included infections: endogenous endophthalmitis, candida retinitis and tubercular choroidal abscess and bilateral pre-foveal hemorrhages. Milder manifestations included paracentral acute middle maculopathy, central serous chorio-retinopathy and voriconazole induced visual symptoms. Final visual acuity was 6/36 or better in the four severe cases and 6/9 or better in the mild cases.Conclusion:This study highlights the retinal manifestations associated with COVID-19 infection and its sequelae. As these patients presented with an association with COVID-19 (either during or after recovery), ophthalmologists should be vigilant and screen for such entities in case of complaints of visual symptoms or in the presence of systemic sepsis. The outcomes can be good with prompt and aggressive management.     

193例感染性眼内炎患者致病原因及临床特点分析

目的　对感染性眼内炎的致病原因、临床诊治及其特点进行分析,为该病的防治提供参考资料。方法　对2014年1月至2017年6月诊治于南昌大学第二附属医院的193例(193眼)感染性眼内炎患者进行回顾性分析,统计患者的致病因素、病原学、治疗及预后等特点。结果　所有患者中外伤性眼内炎137例（71.0%）,铁器类、木制品和物体类是致病的主要原因;眼部手术后感染性眼内炎35例（18.1%）,以白内障和青光眼术后为主;内源性眼内炎15例（7.8%）,以不明原因的病例为主;感染性角膜炎导致者6例（3.1%）。181例患者病原菌培养阳性率为13.3%,以凝固酶阴性葡萄球菌和草绿色链球菌为主要病原菌。眼部手术后及内源性眼内炎患者合并有糖尿病和（或）高血压易感因素的比例较高,玻璃体切割术是主要的治疗方式。感染性眼内炎患者治疗前最佳矫正视力无光感~0.02者占比为86.2%,治疗后无光感~0.02者占比为62.9%、≥0.10者占比为24.9%,差异有统计学意义（P<0.001);其中治疗前后视力有统计学差异的是外伤性及眼部手术后患者,内源性眼内炎患者治疗前后视力比较无统计学差异。感染性角膜炎导致者视力大部分无光感。结论　外伤性和眼部手术后眼内炎是感染性眼内炎的两种主要类型,玻璃体切割术是主要的治疗手段。感染性眼内炎经不同的方式积极治疗后可以控制感染,改善视功能。     

Sight-threatening intraocular infection in patients with COVID-19 in India

Purpose:Intraocular infection in patients with COVID-19 could be different in the presence of treatment with systemic corticosteroid and immunosuppressive agents. We describe the epidemiology and microbiological profile of intraocular infection in COVID-19 patients after their release from the hospital.Methods:We analyzed the clinical and microbiological data of laboratory-confirmed COVID-19 patients from April 2020 to January 2021 presenting with features of endogenous endophthalmitis within 12 weeks of their discharge from the hospital in two neighboring states in South India. The data included demography, systemic comorbidities, COVID-19 treatment details, time interval to visual symptoms, the microbiology of systemic and ocular findings, ophthalmic management, and outcomes.Results:The mean age of 24 patients (33 eyes) was 53.6 ± 13.5 (range: 5–72) years; 17 (70.83%) patients were male. Twenty-two (91.6%) patients had systemic comorbidities, and the median period of hospitalization for COVID-19 treatment was 14.5 ± 0.7 (range: 7–63) days. Infection was bilateral in nine patients. COVID-19 treatment included broad-spectrum systemic antibiotics (all), antiviral drugs (22, 91.66% of patients), systemic corticosteroid (21, 87.5% of patients), supplemental oxygen (18, 75% of patients), low molecular weight heparin (17, 70.8% of patients), admission in intensive care units (16, 66.6% of patients), and interleukin-6 inhibitor (tocilizumab) (14, 58.3% of patients). Five (20.8%) patients died of COVID-19-related complications during treatment for endophthalmitis; one eye progressed to pan ophthalmitis and orbital cellulitis; eight eyes regained vision >20/400. Fourteen of 19 (73.7%) vitreous biopsies were microbiologically positive (culture, PCR, and microscopy), and the majority (11 patients, 78.5%) were fungi.Conclusion:Intraocular infection in COVID-19 patients is predominantly caused by fungi. We suggest a routine eye examination be included as a standard of care of COVID-19.     

Klebsiella pneumoniae invasion syndrome: a case of liver abscess combined with lung abscess,endophthalmitis, and brain abscess

Klebsiella pneumoniae invasion syndrome (KPIS) is a critical multi-site infection that is usually caused by highly virulent Klebsiella pneumonia. It is relatively common in Asian patients with diabetes and leads to sepsis, which has a high mortality rate. We report the case of a man in his early 40s who presented to the hospital with blurred vision in his left eye of 7 days’ duration and fever of 1 day’s duration. After a complete examination, he was diagnosed with KPIS on the basis of his liver abscessation, lung abscessation, endophthalmitis of the left eye and brain abscessation. After needle puncture and drainage of the left eye and liver abscess and anti-bacterial treatment with meropenem, the patient recovered well. When KPIS is suspected, attention should be paid to the sites of infection and the selection of the most appropriate antibiotics, but the most important aim should be to drain the lesions in a timely manner to improve the patient’s prognosis.