单纯玻璃体切除术治疗细菌性眼内炎的疗效评价

目的 评估单纯行玻璃体切除术对外因性细菌性眼内炎的疗效。方法 外因性细菌性眼内炎21例(21只眼)，其中白内障摘除联合人工晶状体植入术后1只眼，眼球穿通伤后20只眼。均作睫状体平部三切口玻璃体切除术，晶状体混浊者一并切除，若有球内异物一并取出，伴视网膜脱离者，重水或气／液交换复位视网膜后行眼内炎光凝、长效气体或硅油填充以及巩膜环扎，术中灌注液内不加入庆大霉素，术毕不作玻璃体腔注药，术后联合抗生索和激素静脉用药。结果 炎症控制20只眼，术后矫正视力提高20只眼，有效率为80．95％。结论 玻璃体切除术对严重细菌性眼内炎而言是最重要的治疗手段。     

Endophthalmitis at the Bristol Eye Hospital: an 11-year review of 47 patients

We reviewed data from 47 patients who were treated for endophthalmitis at our hospital during the 11-year period 1980-90. The most common clinical features were hypopyon (75%), diminished vision (72%), ocular pain (68%), discharge (57%), corneal oedema (51%), conjunctival injection (49%), abnormal red reflex (34%), corneal ulcer (32%) and corneal perforation (6%). A total of 54 isolates were obtained from 41 (87%) of the 47 patients. Gram-positive bacteria were more common (72%), than Gram-negative organisms (22%). Two cases were due to fungi, and herpes simplex virus was isolated from one case. The two most common Gram-positive organisms were coagulase-negative staphylococci (25%), and Staphylococcus aureus (11%), while Pseudomonas aeruginosa predominated among the Gram-negative bacteria isolated (15%). Mixed bacterial species were obtained from 29% of the infected patients, including one from whom Vibrio fluvialis was isolated. Predisposing factors included ocular surgery (60%)--mostly for cataract extraction (47%), penetrating trauma (15%) and periocular (15%) or systemic (11%) infections. All patients received antibiotics (generally chloramphenicol and/or a beta-lactamase-stable penicillin plus an aminoglycoside) prior to culture, when treatment was adjusted according to specific aetiological agents. Seventy-nine per cent of patients received topical or systemic steroids. Vitrectomy (diagnostic and therapeutic) was performed on 21% of patients. Sixty-three per cent of culture-positive patients lost vision (no perception of light) in the affected eye, compared to 17% of culture-negative cases (P < 0.05 Fisher exact test). Similarly, a better visual outcome (acuity of 6/12 or better) was associated with coagulase-negative staphylococcal infection than with streptococcal or fungal infections.(ABSTRACT TRUNCATED AT 250 WORDS)     

玻璃体切割手术治疗化脓性眼内炎

目的 观察玻璃体切割手术治疗化脓性眼内炎的疗效。方法 对1999年6月～2003年2月在我院行玻璃体切割术的14例(14只眼)化脓性眼内炎患者进行回顾性分析。除眼内异物外，其余患者临床诊断化脓性眼内炎后均先采用保守治疗，密切观察1～2天无好转而行玻璃体切割手术。眼内炎的原因：眼球穿通伤13只眼，青光眼术后晚期滤过泡感染1只眼。玻璃体切割手术前先抽取前房及玻璃体腔内液体涂片及培养。采用标准三通道闭合式玻璃体切割手术，7只眼因前房积脓及晶状体前大量渗出和3只眼外伤性白内障影响手术而同时切除晶状体，8只联合巩膜环扎。缝合巩膜切口后玻璃体腔内注射罗氏芬2．5mg及地塞米松0．4mg。术后全身继续使用抗生素及激素1周。术后平均随访14．8个月(2～24个月)．结果 14只眼中术后视力提高12只眼(85．7％)，眼球保留13只眼(92．6％)。5只眼培养阳性。术后玻璃体腔内少量出血2只眼，无其它手术并发症。结论 玻璃体切割手术联合眼内注射抗生素治疗化脓性眼内炎疗效可靠。只要手术时机选择适当，大多数患者能保住眼球，恢复有用视力。     

多重聚合酶链反应快速诊断感染性眼内炎的研究

目的 探讨多重聚合酶链反应（MPCR）快速诊断细菌性、真菌性眼内炎及混合感染的价值。 方法 MPCR法检测常见致病性细菌和真菌菌株，并检测38例患者41只眼（双眼3例，单眼35例）眼内液标本，与细菌和真菌培养结果比较。 结果 MPCR法5 h即可检测出标本中微量细菌和真菌，41份标本MPCR检测阳性34份（82.9％），其中细菌阳性26份，真菌阳性6份，细菌和真菌均为阳性2份，MPCR阳性率明显高于细菌或真菌培养 （χ2＝9.60,P＜0.05）。 结论 MPCR速度快、敏感性和特异性高，有助于细菌性和真菌性眼内炎的快速明确诊断。 （中华眼底病杂志，2004，20：81-83）     

203例外伤性化脓性眼内炎病因分析

目的探讨外伤性化脓性眼内炎的流行病学特点。方法对1999年5月至2005年4月在复旦大学附属跟耳鼻喉科医院住院治疗的外伤性化脓性眼内炎患者的资料进行回顾性分析。结果共203例,203眼; 男170例,女33例;右眼107眼,左眼96眼;年龄1-72岁,平均为(23．6±17．2)岁;以1-5岁组及6-10岁组发病率最高,均为17．2％,其次为31-35岁组(10．8％)。职业上,从事建筑等工作的外来务工者最多(38．4％),学龄前儿童23．2％,中小学生21．2％,农民14．3％,其他3．0％;行眼球清创缝合术的共104例,最早者伤后5 h手术,最晚者伤后1周,24 h以内手术的79例,24 h以上手术的25例。合并球内异物者共50例,18例于24 h内取出,32例于24 h后取出。致伤物中金属穿通伤最多(33．0％,P<0．01),其次由多至少分别为一次性注射器针头、铁屑等球内异物、植物穿通伤、钝挫伤致眼球破裂、石头泥浆等穿通伤、铅笔纸板等穿通伤、爆炸伤、动物伤、致伤物不明和角膜溃疡。104例发生于农村,99例发生于城镇。结论金属穿通伤是外伤性化脓性眼内炎的主要发病因素,预防宣教的重点人群是男性儿童及青壮年外来务工者。     

Ocular toxocariasis in a child: a case report from Kashmir, north India

Toxocariasis is an important zoonotic disease caused by the second stage larva of Toxocara canis or Toxocara cati . The typical clinical syndromes of toxocariasis in humans are visceral and ocular toxocariasis. Ocular toxocariasis may presents as peripheral inflammatory mass, posterior pole granuloma and endophthalmitis. We report a serologically confirmed case of ocular toxocariasis in 12-year-old female. The diagnosis was confirmed by detection of anti- Toxocara antibodies in aqueous and vitreous sample by enzyme-linked immunosorbent assay. We suggest that ophthalmologist in this region should include ocular toxocariasis in differential diagnosis particularly in children and young adults.     

白内障超声乳化术后脓肿型非结核分枝杆菌性眼内炎一例

患者男,48岁,装修工人,因左眼白内障术后眼红、视力下降1周于2011年9月6日来我院就诊,门诊以“左眼眼内炎,人工晶体眼”收入眼科,患者1个月前因“左眼白内障：外伤性？”在我院行白内障超声乳化＋人工晶体植入术,术程顺利.术后18 d（2011年8月28日）患者出现眼红伴视物模糊,怀疑眼内炎,遂行玻璃体抽液培养并玻璃体腔注入万古霉素1 mg,3d后玻璃体抽液培养为非结核分枝杆菌（脓肿型）,因眼部炎症药物控制不佳,病情进一步加重,遂收住院进一步治疗.     

Clinical features and microbiology of post-cataract surgery endophthalmitis with and without intracameral moxifloxacin prophylaxis: Endophthalmitis prophylaxis study report 3

Purpose:This study aimed to analyze the clinical presentations, microbiology, and management outcomes of post–cataract surgery endophthalmitis, with and without intracameral moxifloxacin prophylaxis.Methods:This study was designed as a retrospective, consecutive, comparative case series. Records of consecutive cataract surgery from January 1, 2015, till June 30, 2020, were analyzed. The cases that developed endophthalmitis were analyzed. The endophthalmitis cases were divided by their prophylaxis treatment into two groups: with intracameral moxifloxacin (ICM) and without (N-ICM). Inclusion criteria were (1) age ≥ 18 years, (2) cataract surgery with intraocular lens implantation, (3) endophthalmitis within 6 weeks of cataract surgery, and (4) cataract surgery in the institute by any of the three methods—phacoemulsification, manual small incision cataract surgery, and extracapsular cataract extraction.Results:In the study period, 66,967 cataract surgeries were performed; 48.7% (n = 32,649) did not receive ICM. There was no difference between the N-ICM and ICM groups in the incidence of clinical (n = 21, 0.064% and n = 15, 0.043%; P = 0.23) and culture proven (n = 19, 0.033% and n = 11, 0.023%; P = 0.99) endophthalmitis, respectively. Greater number of patients in the N-ICM group had lid edema (76.2% vs. 40%; P = 0.03), corneal edema (71.4% vs. 33.3%; P = 0.03) and lower presenting vision with available correction (logMAR [logarithm of the minimum angle of resolution] 1.26 ± 1.2 vs. logMAR 0.54 ± 0.85; P = 0.02). The final best-corrected visual acuity following treatment was worse in the N-ICM group (logMAR 1.26 ± 1.2 vs. 0.54 ± 0.85; P = 0.02).Conclusion:Endophthalmitis after intracameral moxifloxacin may have relatively milder signs and symptoms and may respond better to treatment.     

玻璃体切除联合腔内注药治疗晶状体植入术后眼内炎的临床研究

目的探讨玻璃体切除联合腔内注药治疗晶状体植入术后眼内炎的临床效果。方法选择2007年5月至2013年5月成都市第三人民医院眼科收治的行白内障人工晶体植入术后发生眼内炎的患者60例,根据入院先后排序分为两组:对照组29例实施常规腔内注药治疗,观察组31例在对照组的基础上给予玻璃体切除术。对两组患者治疗前后的视力进行统计,评价两组患者的治疗效果,炎症消失时间及并发症发生情况。结果经过治疗,观察组患者视力显著优于对照组,治疗总有效率显著优于对照组,炎症消退时间显著短于对照组,且并发症发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论晶状体植入术后眼内炎是眼科急重症,玻璃体腔内注射联合早期玻璃体切除术对于改善患者预后有重要意义,一旦确诊应立即给予玻璃体腔内注射,并应尽早行玻璃体切除术,以更快地控制炎症,保护患者眼结构和功能。     

硅油填充术在不伴有视网膜脱离外伤性感染性眼内炎的临床应用

目的：观察玻璃体切除联合眼内注药或硅油填充术对眼球穿通伤后合并感染性眼内炎不伴视网膜脱离的疗效。 方法：应用经睫状体平坦部玻璃体切除术，以联合眼内注药或硅油填充术分组治疗30只眼球穿通伤并发感染性眼内炎不伴有视网膜脱离患者，术后予以静脉、结膜下及眼药水途径给予抗感染抗炎治疗。 结果：玻璃体切除术后追踪随访3～12个月，2组30只眼细菌性感染全部控制，术后视力较术前视力有显著性提高，联合眼内注药组19只眼，其中4只眼（21．1％）发生视网膜脱离：联合硅油填充组11只眼，其中术后1只眼（9％）发生视网膜脱离。两组术后并发症发生率均无明显差异（P〉0．05）。 结论：玻璃体切除联合硅油填充术能有效控制炎症，稳定视网膜功能，对一些视网膜情况不佳或炎症难以控制的患者可以考虑术中应用硅油。