外伤性眼内炎不同处理方法的疗效分析

目的：探讨外伤性眼内炎不同处理方法的临床效果。方法：回顾性系列病例研究。选择沧州市中心医院2010年11月至2016年7月收治的外伤性眼内炎患者73例（73眼），其中41眼急诊行玻璃体切割术，32 眼急诊单纯行玻璃体腔注药术。玻璃体切割手术者中21 眼硅油填充，9 眼20% C3F8 填充，11 眼行单纯玻璃体切割术，玻璃体切割手术开始时及玻璃体腔注药前均抽取玻璃体液送细菌培养及药敏试验，真菌培养及药敏试验。结果：患者随访6～24 个月，行硅油填充术后2 眼眼球萎缩，玻璃体腔注药效果不佳改玻璃体切割联合硅油填充术者中1眼最终眼球萎缩，除这3眼外，其余患者眼内炎症均得到控制。眼内取材培养阳性的患者共58 眼，其中混合感染5 眼。共培养致病菌63 株。致病菌谱的构成中，革兰氏阳性菌（62%）所占比例最大，其次为真菌（21%）和革兰氏阴性菌（18%）。从具体菌种看，表皮葡萄球菌为最常见的致病菌（25%），然后依次是曲霉菌（14%）和金黄色葡萄球菌（11%）。结论：对于外伤性眼内炎，一旦确诊，需根据病情即刻采取治疗措施，其中玻璃体切割术以及玻璃体腔注药术均为有效的治疗措施。

Outcome for Different Treatments of Traumatic Endophthalmitis

Objective: To assess the effectiveness of the different clinical treatments of traumatic endophthalmitis.Methods: This retrospective study included one eye of 73 patients diagnosed with traumatic endophthalmitis from November 2010 to July 2016 at Cangzhou Municipal Central Hospital. Forty-one patients were treated by vitrectomy and 32 immediately received intravitreal injection. For vitrectomy patients, 21 eyes received silicon oil tamponade, 9 eyes received C3F8 tamonade, and 11 eyes received no tamponade. At the beginning of each vitrectomy, vitreous purulence was extracted for bacterial and fungal culture and for drug sensitivity. Results: During the following 6-24 months, two victrectomized eyes with silicon oil tamponade and one eye with intravitreal injection atrophied. Endophthalmitis was controlled for the remaining 70 eyes. Sixty-three strains of organisms were isolated from 58 eyes with traumatic endophthalmitis, including five eyes with polymicrobial infection. Among them, 39(62%) were gram-positive, 13(21%) were fungi, and 11(18%) were gram-negative bacteria. The most common organisms were Staphylococcus epidermidis at 25% of the eyes, Aspergillus at 14%, and Staphylococcus aureus at 11%. Conclusions: For traumatic endophthalmitis, once confirmed, actions should be undertaken immediately. Vitrectomy and antimicrobials are both effective treatments.