一次性注射针头致儿童眼内炎32例临床疗效分析

目的分析一次性注射针头致儿童眼内炎的临床特点和治疗效果。方法对32例一次性注射针头致儿童眼内炎的就诊时间、临床表现及治疗结果进行回顾性分析。结果农村儿童受伤后就诊迟，虽经积极的手术治疗，但视功能损害严重。结论化脓性眼内炎一经确诊，应积极行玻璃体腔注药，联合玻璃体切割术可提高治疗效果。     

Management of Infectious Endophthalmitis

Diagnostic anterior chamber and vitreous aspiration confirmed an infectious etiology in 78 of 140 eyes (56%) with suspected endophthalmitis. In 27 eyes the vitreous aspirate was positive, while the anterior chamber aspirate was negative. Intraocular antibiotics were used in 88 eyes including 50 which underwent therapeutic vitrectomy. Vision of 20/20 to 20/400 was achieved in 57% of recently operated, culture-positive eyes treated with intraocular antibiotics, and in 59% of those treated with combined vitrectomy and intraocular antibiotics.     

Endogenous Endophthalmitis Among Patients with Candidemia

Thirty-eight patients with fungemia were examined prospectively for development of endophthalmitis. Endophthalmitis was present in 10 of 27 (37%) patients with Candida albicans fungemia. Only one patient with nonalbicans fungemia developed endophthalmitis. Of the preselected factors studied, only hemodialysis and parenteral hyperalimentation correlated with an increased incidence of endophthalmitis. Antibody titers by latex agglutination were of little predictive value for endophthalmitis. Antigen titers by latex agglutination were performed in four cases with endophthalmitis. Antigenemia was demonstrated in three of the four patients, all of whom had negative antibody serologies. Although inconclusive, the preliminary data indicate the test may prove to be of clinical value. Periodic ophthalmoscopic examinations should be considered mandatory in the evaluation of patients with fungemia.     

Red eyes as the initial presentation of systemic meningococcal infection

The present paper is a report of a 14-month-old boy who presented with fever, coryzal symptoms and red eyes. The patient developed a generalized tonic clonic convulsion on day 2 of his illness. Ophthalmological assessment demonstrated bilateral hypopyon and vitreous opacity resulting from endophthalmitis. Cerebrospinal fluid was positive for Neisseria meningitidis (A, C, Y, W 135) by latex agglutination. He was treated with high dose intravenous cefotaxime and intravitreal ceftazidime. He made good recovery and his vision was preserved. In view of the potential morbidity and mortality associated with systemic meningococcal infection, the presence of red eye and hypopyon provides important diagnostic clues indicating the need to investigate beyond superficial conjunctivitis. It should prompt the clinician to recognize endopthalmitis early and accurately diagnose this serious disease.     

Topical anaesthesia: a risk factor for post‐cataract‐extraction endophthalmitis?

Purpose: To investigate if the incidence of postoperative endophthalmitis in temporal clear corneal cataract surgery is influenced by the use of topical anaesthesia compared to retrobulbar anaesthesia. Methods: A retrospective study was conducted of one surgeon's cataract surgery between October 1997 and October 2001. Results: Between October 1997 and May 2000, there were 633 cataract extractions performed with 219 patients operated under topical anaesthesia and 414 under retro­bulbar injection. The selection criteria were that surgically easier cases underwent topical anaesthesia. There were five patients who suffered postoperative endophthalmitis in their first week, of which four cases were under topical anaesthesia. This was shown to be borderline significance of P = 0.05 using the Fischer exact 2‐tailed test. There was a complicated case, operated under retrobulbar anaesthesia, who had a low‐grade endophthalmitis in the second postoperative week. The four topical cases and the case from the second week all grew Staphylococcus epidermidis. The retrobulbar case developing endophthalmitis in the first week grew alpha haemolytic Streptococcus. After May 2000, there was a change to performing all cataract surgery under retrobulbar anaesthesia and the next 453 cases had no incidence of endophthalmitis. Conclusion: Topical anaesthesia techniques in temporal clear corneal cataract extraction may be a factor in endophthalmitis.     

Silicone oil in the surgical treatment of endophthalmitis associated with retinal detachment

Purpose: To investigate the useof silicone oil in thepatients who had undergone vitrectomy for the treatment of endophthalmitis associated with retinal detachment.Methods: Six consecutive cases of endophthalmitis associated with retinal detachment were included in the study. The mean age of the 4 males and 2 females was 47.25 ± 23.76 years. Endophthalmitis associated with retinal detachment occurred following perforating injuries in 4 eyes, pneumatic retinopexy in 1 eye and cataract surgery complicated with vitreous loss in 1 eye. Preoperative visual acuity was light perception-only in all eyes. Red reflex was absent in all eyes. All the patients underwent vitreous tapping,encirclement, vitrectomy ,liquid-gasexchange, endolaser photocoagulation and silicone oil injection. Results: Mean follow-up time was 14.3 ± 7.20 months. The microorganisms that were isolated from the vitreous aspiration were Staphylococcus epidermidis in 3 cases, Staphylococcus aureus in 1 case. Remaining cases were culture negative. Retinal breaks could be found in 4 eyes. Inflammation subsided significantly at 5 days in all cases. Final retinal reattachment and treatment of endophthalmitis was achieved in 5 eyes at the end of follow-up . Final visual acuity was 20/40 in 1 case, counting finger in 4 cases and no light perception in 1 case. The postoperative complications were optic atrophy in 1 eye, epiretinal membrane in 2 eyes and phitisis bulbi in 1 eye.Conclusion: Silicone oil, a retinal tamponading agent that has antimicrobial activity, may have benefical effect in the surgical treatment of endophthalmitis associated with retinal detachment.     

Pyogenic liver abscess complicated by endogenous endophthalmitis

Background: Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess. Methods: Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed. Results: There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye. Conclusion: Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.     

Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post‐mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.     

31例感染性眼内炎的临床分析与治疗

目的分析感染性眼内炎的病因构成、病原学检查及治疗的临床效果。方法对感染性眼内炎患者31例31眼的临床资料进行回顾性分析。外伤感染18例18眼（异物伤13例,利器穿通伤5例）;白内障手术后感染9例9眼;角膜移植术后感染1例1眼;角膜葡萄肿致眼球破裂感染2例2眼;角膜溃疡感染1例1眼。结果23例行玻璃体取样培养,12例检出病原体,培养阳性率为52．2％。经治疗后,视力提高17眼（55．5％）,视力无改善4眼（12．9％）,视力下降1眼（3．2％）,眼内容物剜除5眼（16．1％）,2例转院后无随访,1例白内障术后经保守治疗仍无光感者自动放弃治疗出院后无随访,1例手术前后均无法配合检查视力。结论眼外伤和白内障手术是目前导致感染性眼内炎的主要原因,尽早行玻璃体注药或联合玻璃体切割术是治疗眼内炎的有效方法。