开放性眼球外伤迟发型感染性眼内炎救治分析

目的探讨眼球开放伤迟发型感染性眼内炎的临床诊断、救治方案、疗效及预后。方法10例（10眼）不同原因的眼球穿孔伤引发的迟发型感染性眼内炎，根据病程长短、病情轻重等，对其中1例行玻璃体注药，1例行玻璃体注药联合前房冲洗，其余8例接受玻璃体切除联合其它治疗。结果10例中有6例经涂片或培养病原菌呈阳性。病原菌培养阳性病例中多数为毒力较弱的G＋或G-球菌或条件致病菌。1例阴沟肠杆菌感染者接受玻璃体注药联合前房冲洗后炎症未能控制并有迅速发展为全眼球炎的迹象，最终行眼内容摘除术，其余9例均得到有效救治，眼内炎症得到有效控制，其中5例达到0．1以上视力。结论开放性眼球外伤引发的迟发型感染性眼内炎比较少见，一般致病菌毒力较弱，症状较轻，容易被忽略，因此，及早发现和准确诊断至关重要，及时采取玻璃体手术等综合治疗可以有效控制炎症，明显提高治疗效果。

Clinical observation of delayed infectious endophthalmitis following open globe injuries

Objective To evaluate the clinical diagnosis,treatment options,curative effect and prognosis of delayed infectious endophthalmitis following open globe injuries.Methods According to course and severity of 10 cases of delayed infectious endophthalmitis caused by open injuries,1 case received vitreous injection,1 case received vitreous injection combined anterior chamber lavage,the other 8 cases received vitrectomy combinated other therapy.Results Pathogenic bacteria were found in 6 cases by smear or bacterial culture.G + or G - cocci with weak virulence or opportunistic pathogen were found in most of these culture positive cases.One case was infected with enterobacter cloacae,which received vitreous injection combinated anterior chamber lavage,but failed to control the rapid development of the inflammation,finally received evisceration.The remaining 9 cases had received effective treatment,in which 5 cases achieved visual acuity of 0.1 or above.Conclusion Delayed infectious endophthalmitis following open globe injuries was rarely occurred,and the virulence of these pathogenic bacteria was weak,the symptoms was mild,so it' s easily be overlooked in early stage of the whole course of disease.Accordingly,early detection and accurate diagnosis are critical,vitrectomy and combined therapy can effectively control the inflammation and significantly improve the prognosis.