人工晶状体术后慢性细菌性眼内炎的治疗效果观察

目的 通过对白内障超声乳化摘除联合人工晶状体植入术后慢性细菌性眼内炎的治疗效果观察，提出治疗建议。方法 回顾分析2004-2009年收治的4例4眼人工晶状体术后慢性细菌性眼内炎，观察其发生时间、眼部体征。经平坦部玻璃体切除、晶状体后囊膜环形撕囊联合眼内注入万古霉素作为首选治疗方法。切除的玻璃体和撕下的晶状体后囊膜进行涂片和培养微生物检查。复发病例联合全身应用大环内酯类抗生素治疗。术后观察其眼部情况、视力。结果 4例平均发病时间是人工晶状体术后8周（5～11周）。其中女性3人、男性1人，年龄平均75岁（67～81岁）。玻璃体切除前视力分别是眼前手动1眼、数指2眼、1眼0.06。丙酸痤疮杆菌感染3跟，表皮葡萄球菌感染1眼。其中两眼分别于术后7周和5周复发。复发的两眼间断结膜下注射地塞米松和妥布霉素，联合全身应用罗红霉素和阿奇霉素8周，炎症控制。随访16～36月，无复发。最后随访眼部无炎症表现，晶状体囊膜清晰和玻璃体腔均清澈，最佳矫正视力分别是0.8、0.5、0.2和0.3。结论 人工晶状体植入术后慢性眼内炎玻璃体切除和晶状体后囊膜环形撕除术后，局部和全身应用抗生素时间要适当延长以防治复发，大环内酯类抗生素的治疗作用应受到重视。

Treatment effect of chronic pseudophakic bacterial endophthalmitis

Objective To evaluate the Ceatment effect of chronic bacterial endophthalmitis after intraocular lens (IOL) implantation and make some treatment advice. Methods Medical records of 4 cases of microorganism positive pseudophakic endophthalmitis in our unit were reviewed between 2004 and 2009. Initial therapy included pars plana vitrectomy (PPV) and posterior capsulorhexis combined with intraocular vancomycin. Subconjunctival antibiotics and steroid was applied after the operation. The removed capsule was divided for smear staining and aerobically and anaerobically culture together with the removed vitreous. Oral azithromycin and roxithomycin was a treatment option for recurred patients. Results Four eyes of 4 patients were reviewed that 3 females and 1 male. The average age was 75 years old (67 to 81 years). The mean time period between cataract surgery and symptoms of endophthalmitis was 8 weeks (5 to 11 weeks). Visual acuity before surgery was hand movement in one eye, counting fingers in 2 eyes and 0.06 in one eye. Propionibacterium acnes were found in 3eyes and coagulative-negative staphylococcus in 1 eye. Vitreous base abscess, retinal vasculitis and haemorrhage intermediate uveitis, vitreous veil could be found during operation. Two recurred eyes were successfully cured by repeated subconjunctival dexamethasone and tobramycin, oral azithromycin and roxithomycin. No recurrence was noticed at last follow-up over 16 months. The best corrected visual acuity was 0.8, 0.5, 0.2 and 0.3 at last follow-up, respectively. Conclusious After PPV and posterior capsulothexis, the antibiotics application should be prolonged to avoid recurrence in chronic pseudophakic bacterial endophthalmitis. The role of macrolides antibiotics in treating the chronic pseudophakic bacterial endophthalmitis deserves respect.