内源性感染性眼内炎的临床分析

目的：探讨内源性眼内炎的易感因素、临床表现、误诊原因和治疗方法及效果。方法：对1998年6月至2001年10月内源性眼内炎患者15例(18只眼)，进行回顾性临床分析。结果：15例中，大手术后败血症患者3例，糖尿病患者2例，肝脓肿患者2例，臀部脓肿患者1例，不明原因发热患者4例，不明原因者3例。主要临床表现为眼红痛和视力损害，伴或不伴全身症状。早期被误诊为虹膜睫状体炎或葡萄膜炎者共11例(73.3％)。15只眼行玻璃体切割术，术后4只眼出现视网膜脱离，大多数患者保存了有用视力。另3只眼来诊时即已眼球萎缩，未作处理。结论：大手术后败血症、糖尿病、深部脓肿。不明原因发热可能为内源性眼内炎的易感因素。早期玻璃体液或房水培养以及血培养相当重要。玻璃体手术联合全身应用抗生素或抗真菌药物是治疗内源性眼内炎的有效手段。

Clinical analysis of endogenous infectious endophthalmitis

Objective:To investigate the predisposing factors,clinical manifestations,causes of misdiagnosis and treatment,as well as the therapeutic outcomes of endogenous endophthalmitis.Methods:Deta of 15 patients (18 eyes) with endogenous endophthalmitis,seen from June 1998 to October 2001,were analysed retrospectively.Results:Of the 15 patients:3 had septicemia after a major operation,2 had diabetis,2 had liver abscess and 1 had buttocks abscess,4 had fever of unknown origin and other 3 had no obvious predisposing factors.Cardinal manifestations were ocular redness,pain and visual impairment with or without systemic symptoms.In early stage,11 patients (73.3%) were misdiagnosed as iridocyclitis or uveitis.In all 15 eyes vitrectomy was performed.After surgery,4 eyes had developed retinal detachments,and 8 patients conserved available visions,but three eyes were atrophic.Conclusion:Diabetic patients and patients with history of septicemia having major surgeries,deep abscess (liver abscess and buttocks abscess),as well as fever of unknown origin were predisposing population of endogenous endophthalmitis.For early diagnosis,aspiration from anterior chamber or vitreous cavity for culture and blood culture were very important.Sensitive antibiotic or antifungal systemic application and vitrectomy are effective methods for treating endogenous endophthalmitis.