青光眼滤过泡相关性眼内炎的临床分析

目的 探讨青光眼滤过手术后滤过泡相关性眼内炎的临床特点、发生原因、治疗方法及预后情况。方法 回顾性病例系列研究。对1997年1月至2009年12月收治的全部滤过泡相关性眼内炎患者的临床资料进行回顾性分析,主要包括患者治疗前眼部情况、青光眼类型,滤过手术后早期有无低眼压、浅前房及滤过泡渗漏情况,既往眼病史及手术史,眼内炎发生后眼部B超检查结果,病原学检查结果,治疗方法及视力预后等情况。结果 共收集19例（20只眼）眼内炎患者的临床资料。其中男性16例（17只眼）,女性3例（3只眼）;年龄15～71岁,平均(46.9±16.1)岁。除在外院手术的5例（5只眼）外,14例（15只眼）患者术中均使用抗代谢药物（丝裂霉素C0.5 g/L,巩膜瓣下放置浸有药液的湿棉片2 rmin）。术后早期8只眼出现浅前房、低眼压。8只眼行2次以上青光眼滤过手术。滤过泡相关性眼内炎发病时间介于末次手术后15 d至10年之间,平均(29.5 ±32.2)个月,主要表现为滤过泡感染、前房炎性渗出和积脓、玻璃体显著混浊。11只眼经溪流试验检查,7只眼(63.6％)阳性,表明有滤过泡渗漏;其中下方滤过泡渗漏致眼内炎者5只眼。19例患者进行22次病原学检查,其中阳性者8例(36.4％),以葡萄球菌为主,对万古霉素敏感。早期行玻璃体手术联合全身及局部抗生素治疗,可有效控制感染性眼内炎,其中16只眼(80.0％)治疗后视力提高,11只眼(55.0％)视力恢复至患病前。13只眼(68.4％)眼压保持正常,5只眼(26.3％)用1种或2种降眼压药物眼压控制,1只眼(5.3％)再次行小梁切除术治疗。结论 滤过泡相关性眼内炎是青光眼滤过手术中严重威胁患者视力的并发症,可发生于术后任何时期,其发病急、病情进展迅速,葡萄球菌是主要的致病菌。滤过泡渗漏是发生滤过泡相关性眼内炎的可能原因。大多数患者一经明确诊断即应行玻璃体腔内注药和（或）玻璃体切除术治疗,及时合理的治疗可在一定程度上挽救患者视功能。

Clinical analysis of glaucoma bleb-associated endophthalmitis

Objective To investigate the clinical characteristics, causative organisms, treatment procedures and prognosis of glaucoma bleb-associated endophthalmitis. Methods It was a retrospective case series study. All cases were patients with glaucoma bleb-associated endophthalmitis treated at Shandong Eye Institute, Qingdao Eye Hospital between January 1, 1997 and December 31, 2009. All patients had prior glaucoma filtering surgery. Results Nineteen patients (20 eyes ) were identified. There were 16 males (17 eyes, 85％) and 3 females (3 eyes, 15％). The mean age at presentation was(46.9 ±16.1 )years( ranged 15 to 71 years). In 14 patients ( 15 eyes) the glaucoma operation was performed in our hospital, and an antifibrotic agent was used ( mitomycin, 0.5 g/L, 2 min), shallow anterior chamber and hypotony occurred in early postoperative period in 8 eyes (53.3％). Glaucoma operation was performed in other hospitals in 5 patients (5 eyes). Eight cases ( 8 eyes) received glaucoma operation more than two times. The mean interval between the last filtering surgery and the diagnosis of endophthalmitis was 29.5 ±32.2 months (ranged 15 days to 10 years). Mainly clinical features included bleb infection, anterior chamber inflammatory exudation, hypopyon and vitreous opacities. Bleb leakage occurred in 63.6％ eyesand bleb was located inferiorly in 5 eyes ( 25.0％ ). The incidence of inferior bleb-related endophthalmitis was higher than that of the superior bleb ( 19.2％ versus O. 6％ ). The most common causative organisms were staphylococcus species. The initial treatments included intravenous and topical antibiotics, intravitreal injection of antibiotics, pars plans vitrectomy. These treatments could effectively control the endophthalmitis. The visual prognosis was good, 80％ patients achieved increase of vision after treatment and 55％ patients regained original visual acuity. Eye ball was preserved in 13 (68.4％) of 19 eyes, intraocular pressure (IOP) was controlled at last follow-up after the treatment of endophthalmitis. IOP was controlled by 1 or 2 durgs in 5 eyes (26.3％)and 1 eye (5.3％) received trabeculectomy. Conclusions Glaucoma bleb-associated endophthalmitis is a serious complication following glaucoma filtering surgery which threats patients visual acuity significantly. It can occur at any time after the operation. Staphylococcus species is the most common causative organisms. Bleb leakage and inferior bleb location are the possible causative factors. Patients should be immediately treated by intra-vitreal injection and/or vitrectomy. If the treatment is timely and effective, the visual prognosis is good.