眼球穿孔伤致化脓性眼内炎治疗失败原因分析

目的 探讨眼球穿孔伤所致化脓性眼内炎治疗失败的原因。方法 小儿因眼球穿孔伤致化脓性眼内炎23例，伤后经5—17天药物治疗无效后转手术治疗。术前视力光感—数指，前房渗出、积脓及玻璃体积脓。所有病例均行玻璃体切除手术。术后继续抗生素和皮质类固醇药物治疗，随访3—8周。结果 手术中见所有病例在锯齿缘处有厚密的奶油样脓液，因粘连紧密无法完全切除。3例发生医源性视网膜裂孔，采用硅油填充术。20例术后发生视网膜脱离，8例再次接受手术治疗。14例玻璃体培养为阴性结果。术后眼内炎控制，但因视网膜脱离最终全部术眼眼球萎缩。结论 眼球穿孔伤所致化脓性眼内炎，一旦锯齿缘出现难以清除的奶油样脓液，治疗极为困难且预后极差。

Failure of treatment in endophthalmitis caused by perforating injury

Objective To discuss the failure of treatment in a group of endophthalmitis caused by perforating injury. Methods After failure of topical and systemic antibiotic treatment, 23 cases of endophthalmitis caused by perforating injury in children turned to vitrectomy therapy. Before operations, their visual acuity ranged from light perception to counting finger. There were significant amounts of fibrin or hypopyon in anterior chamber and the vitreous yellowish - white abscesses. The antibiotics with steroid were applied after surgery, followed by a period of follow up for 3 to 8 weeks. Results During the surgery, in no case could the creamily purulence along the zone of ora serrata be removed completely because they were closely attached to each other while the infiltrated vitreous was being excised. latrogenic retinal tear occurred in 3 cases who were filled with silicone oil. The retinal detachment occurred in 20 cases and secondly operation was performed in 8 cases. The vitreous samples were sent for culture in 14 cases and negative results were obtained.The final results of retinal detachment were ocular atrophy in all cases, though the endophthalmitis was controlled. Conclusion Difficult rescue and poor prognosis are the characteristics of severe endophthalmitis with a lot of creamily purulence on the zone of ora serrata caused by perforating injury.