193例感染性眼内炎患者致病原因及临床特点分析

目的　对感染性眼内炎的致病原因、临床诊治及其特点进行分析，为该病的防治提供参考资料。方法　对2014年1月至2017年6月诊治于南昌大学第二附属医院的193例(193眼)感染性眼内炎患者进行回顾性分析，统计患者的致病因素、病原学、治疗及预后等特点。结果　所有患者中外伤性眼内炎137例（71.0%），铁器类、木制品和物体类是致病的主要原因；眼部手术后感染性眼内炎35例（18.1%），以白内障和青光眼术后为主；内源性眼内炎15例（7.8%），以不明原因的病例为主；感染性角膜炎导致者6例（3.1%）。181例患者病原菌培养阳性率为13.3%，以凝固酶阴性葡萄球菌和草绿色链球菌为主要病原菌。眼部手术后及内源性眼内炎患者合并有糖尿病和（或）高血压易感因素的比例较高，玻璃体切割术是主要的治疗方式。感染性眼内炎患者治疗前最佳矫正视力无光感~0.02者占比为86.2%，治疗后无光感~0.02者占比为62.9%、≥0.10者占比为24.9%，差异有统计学意义（P<0.001)；其中治疗前后视力有统计学差异的是外伤性及眼部手术后患者，内源性眼内炎患者治疗前后视力比较无统计学差异。感染性角膜炎导致者视力大部分无光感。结论　外伤性和眼部手术后眼内炎是感染性眼内炎的两种主要类型，玻璃体切割术是主要的治疗手段。感染性眼内炎经不同的方式积极治疗后可以控制感染，改善视功能。

Pathogenic causes and clinical characteristics analysis of 193 patients with infectious endophthalmitis

Objective　To analyze the pathogenesis, clinical diagnosis, treatment and characteristics of infectious endophthalmitis, so as to lay the foundation for its prevention and treatment. Methods　A total of 193 patients (193 eyes) with infectious endophthalmitis diagnosed and treated in the Second Affiliated Hospital of Nanchang University from January 2014 to June 2017 were reviewed to statistically analyze the pathogenic factors, etiology, treatment and prognosis. Results　Among the 193 patients, traumatic endophthalmitis were 137 cases (71.0%), and the main causes were iron, wood and other objects. Infectious endophthalmitis after eye surgery were 35 cases (18.1%), which were mainly from cataract and glaucoma surgery. There were 15 cases (7.8%) of endogenous endophthalmitis, most of which were of unknown cause. Infectious keratitis induced endophthalmitis were 6 cases (3.1%). The positive rate of pathogen culture for 181 patients was 13.3%, and coagulase negative staphylococcus and viridans streptococcus were the main pathogens. Patients with infectious endophthalmitis after eye surgery and endogenous endophthalmitis were more likely to suffer from hypertension and/or diabetes. Pars plana vitrectomy was the main treatment method. The best corrected visual acuity (BCVA)of patients with infectious endophthalmitis mainly ranged from no light perception to 0.02 (86.2%) before treatment; after treatment, the proportion of BCVA ranging from no light perception to 0.02 was 62.9%, and BCVA≥0.10 was 24.9%. The difference was statistically significant (P<0.001) and the differences were mainly reflected in traumatic endophthalmitis and infectious endophthalmitis after eye surgery, and there was no statistical difference in endogenous levels. Most of the patients with endophthalmitis induced by infectious keratitis had no light perception. Conclusion　The traumatic endophthalmitis and infectious endophthalmitis after eye surgery are two main types of infectious endophthalmitis. Pars plana vitrectomy is the main treatment method. The infection can controlle and the visual function can improved by different active treatment methods in infectious endophthalmitis.