肺炎克雷伯杆菌性肝脓肿眼内炎31例

目的 探讨肺炎克雷伯杆菌性肝脓肿眼内炎的临床特征.方法 收集来自眼科、肝胆外科、内分泌科、血液内科及呼吸内科收治的肺炎克雷伯杆菌性肝脓肿眼内炎的患者共31例(37眼)临床资料,分析患者一般资料、眼部查体、辅助检查、治疗及预后情况.结果 患者主要为中老年男性,多数合并糖尿病.10眼无眼部症状,在行眼部检查时发现眼内炎表现...     

Non-infectious endophthalmitis associated with trypan blue use in cataract surgery

Background The visualization of the anterior lens capsule is greatly enhanced by trypan blue staining facilitating the creation of a continuous curvilinear capsulorhexis. Trypan blue has been deemed safe in this setting. Methods We report the findings and management of a retrospective interventional case series comprising three eyes that developed non-infectious endophthalmitis following routine trypan blue staining of the anterior lens capsule with the same batch of Vission (0.6 mg/ml) during uncomplicated small incision phacoemulsification of 17 consecutive eyes. Results On post-op day 1, 18% had an increased cellular response in the anterior chamber and anterior vitreous precluding fundus visualization, 12% had a hypopyon. Initial visual acuity (VA) ranged from hand motions to light perception. Eyes were initially managed with topical and oral steroids. Two eyes underwent vitrectomy. Vitreous cultures were all negative. One eye had a repeat vitrectomy to remove an epiretinal membrane. Final VA achieved was 20/80, 20/20 and 20/20. Conclusion Trypan blue may be associated with severe intraocular inflammation. Presented in part at the 2005 Annual Meeting of the Association of Research in Vision and Ophthalmology (Ft. Lauderdale, FL, May 2006), at the 2005 XXIII Annual Meeting of the American Society of Retinal Specialists (Montreal, Canada, August 2005), at the 2005 Annual Meeting of the American Academy of Ophthalmology (Chicago, Il, Oct 2005) and at the II Congress of the Sociedad Panamericana de Retina y Vítreo (Cartagena de Indias, Colombia, May 2006). Supported in part by a Tyson ARVO Travel Award by the Pan American Ophthalmological Foundation.     

前房冲洗联合万古霉素前房注射治疗白内障术后早期眼内炎

目的:评价前房冲洗联合万古霉素前房注射治疗白内障术后早期感染性眼内炎的临床效果。方法:对我院于2006-01/2007-07发生的3例白内障术后早期眼内炎,经眼部B超明确玻璃体内无明显混浊后,急诊行前房冲洗联合万古霉素前房注射术。观察术后疗效。结果:3例眼内炎患者治疗后视力分别为0.4,0.2,0.6,无明显手术并发症,无1眼摘除眼球。结论:早期诊断,急诊行前房冲洗联合万古霉素前房注射术是治疗白内障术后早期眼内炎的有效方法。     

How to prevent endophthalmitis in cataract surgeries?

Postoperative endophthalmitis is a very devastating complication and every step should be taken to reduce its occurrence. Unattended air conditioning filter systems are often the culprits and regular maintenance of the filters is of paramount importance. Shedders of pathogenic organisms amongst the theater personnel should be identified by regular screening and should be promptly treated. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of prophylactic intracameral antibiotics or prophylactic subconjunctival antibiotic injection at the conclusion of cataract surgery, placing a patch after the surgery for at least 4 h and initiating topical antibiotics from the same day of surgery helps to lower the frequency of postoperative endophthalmitis. Intraoperative posterior capsule rupture and anterior vitrectomy are risk factors for acute endophthalmitis, and utmost care to prevent posterior capsular rent should be taken while performing cataract surgery. Also, in case of such complication, these patients should be closely monitored for early signs of endophthalmitis in the postoperative period. In the unfortunate event of endophthalmitis the diagnosis should be prompt and treatment must be initiated as early as possible.     

Amycolatopsis sulphurea as the first reported agent of endophthalmitis in a patient after penetrating eye trauma with intraocular foreign body: A case report

We report an Amycolatopsis sulphurea endophthalmitis after the surgical repair of penetrating eye trauma with a metallic intraocular foreign body. A 27-year-old male referred with occupational injury by a nail from his left eye. Endophthalmitis occurred 12 h after the removal of foreign body and repair of the globe. The culture of vitreus samples revealed gram-positive bacillus proliferation, confirming A. sulphurea. Endophthalmitis was eradicated successfully with intravitreal, topical, and systemic antibiotics. To the best of our knowledge, this is the first case, reporting A. sulphurea endophthalmitis.     

感染性眼内炎致病原因及病原菌分布

目的 了解感染性眼内炎的致病原因、病原菌分布及耐药情况。方法 回顾性分析2016年1月-2018年12月某院病历系统中感染性眼内炎患者的临床资料。结果 90例感染性眼内炎主要由眼外伤所致（56.7%）,20例（22.2%）由眼部手术后引起,其中19例（95.0%）为白内障手术合并人工晶状体植入术引起。52株感染性眼内炎致病菌中,革兰阳性菌占50.0%（26株）,主要为表皮葡萄球菌（13株）,革兰阴性菌占30.8%（16株）,主要为铜绿假单胞菌（6株）、肺炎克雷伯菌（4株）。表皮葡萄球菌对万古霉素、利奈唑胺、利福平、替加环素敏感率为100.0%,对青霉素及苯唑西林敏感率较低（<50%）。结论 感染性眼内炎多由眼外伤和眼部手术尤其是白内障手术引起,致病菌以表皮葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌为主。     

Orbital Cellulitis and Endophthalmitis in Pseudomonas Septicemia

We report a case of concurrent orbital cellulitis and endophthalmitis that resulted from endogenous complications of community-acquired Pseudomonas aeruginosa bacteremia in an apparently healthy individual. Pseudomonas pneumonia and extensive focal skin lesions of ecthyma gangrenosum also complicated the condition. The presence of drug-induced neutropenia was a risk factor in this patient. Simultaneous orbital cellulitis and endophthalmitis developed and rapidly progressed. Intravenous, intravitreal, and topical antibiotics were administered along with frequent eye wash with normal saline to dilute copious purulent discharge from a deep subcutaneous abscess of lower eyelid. Because of the exocellular products of Pseudomonas aeruginosa, the sclera and corneal stroma were degraded, resulting in nearly perforated cornea. Tarsoconjunctival flap from the upper eyelid was performed to reconstruct the thinning areas. After the infection was controlled, the patient's ultimate visual acuity was light perception.     

The Pros and Cons of Intravitreal Triamcinolone Injections for Uveitis and Inflammatory Cystoid Macular Edema

Intravitreal triamcinolone acetonide (IVTA) injections are gaining in popularity and are regularly administered nowadays for various ocular diseases. This paper presents a literature review on the use, efficacy, and complications of IVTA application in non-infectious uveitis and inflammatory cystoid macular edema (CME). In addition, we describe the experiences of our own institute. IVTA applications brought about a quick improvement in vision in the majority of cases. Drawbacks included the temporary duration of the effect with the need for repeated injections which re-exposed patients to the risk of complications. The risk of bacterial endophthalmitis was 0.5% and was further influenced by the specific IVTA preparation. Based on the literature review, we chose ready-for-use IVTA injections prepared by our pharmacy department, in which 90% of the toxic additives were removed and the dispensed dose of triamcinolone acetonide was validated to diminish the risk of endophthalmitis. Elevated intraocular pressure (IOP) was seen in 30–43% of the eyes and cataract developed in 29% of the eyes of patients, who were usually of advanced age. In conclusion, the rapid effect of IVTA might be of value in severe presentations of non-infectious uveitis and CME and might shorten the time interval needed for the improvement.     

外伤性化脓性眼内炎合并眶蜂窝织炎的护理

目的探讨外伤性化脓性眼内炎合并眶蜂窝织炎的护理方法。方法通过病例对12例外伤性化脓性眼内炎合并眶蜂窝织炎的临床特点、并发症、治疗效果和预后及相关因素进行观察和分析。结果 12例外伤性化脓性眼内炎合并眶蜂窝织炎患者中,发生眼内炎时间大于24小时,平均时间（4.75±3.28）天,所有病例一经诊断为外伤性化脓性眼内炎即予抗炎、抗感染和散瞳等治疗,并采取相应的护理措施和对症处理,经数天治疗,患者眼部炎症控制出院,无发生颅内感染等并发症。结论外伤性化脓性眼内炎合并眶蜂窝织炎是一种严重危害视功能的眼科急症,做好相应充分适当的护理,有利于治疗效果的实现和减少并发症的发生。     

Nosocomial acute-onset postoperative endophthalmitis at a university teaching hospital in China

A retrospective study of all intra-ocular operations performed at Zhongshan Ophthalmic Centre, China between 1 January 2000 and 30 December 2009 was conducted to gain further knowledge about nosocomial acute-onset postoperative endophthalmitis. In total, 147,244 intra-ocular operations were performed during this period. Acute-onset postoperative endophthalmitis was diagnosed in 29 cases, giving a frequency of 0.020%. The frequency remained low and did not increase over the 10-year period. The highest rate of endophthalmitis was found following secondary intra-ocular lens implantation (0.129%). Cataract surgery had a rate of 0.01%, which is on the lower end of estimates from other large-scale studies. Gram-positive bacteria were the most commonly isolated organisms (71%), with the majority being Staphylococcus epidermidis (64%). However, no S. epidermidis was identified in the cases following cataract extraction; these patients received intracameral vancomycin at the end of the procedure. Visual outcomes of patients with postoperative endophthalmitis were generally poor. Three (10%) patients had visual acuity (VA) ≥20/40 at the final follow-up visit (all had undergone cataract surgery) and 15 (52%) patients had VA ≤20/400 at the final follow-up visit (10 had undergone pars plana vitrectomy). Factors associated with poor visual outcomes included initial VA of hand motions or worse, and positive culture results. The?results of this 10-year study may serve as a source of comparison for other centres and future studies.