内源性真菌性眼内炎的临床特征和疗效分析

目的探讨内源性真菌性眼内炎的临床特征及其诊断和治疗方法。设计回顾性病例系列。研究对象2006—2009年北京同仁医院经玻璃体培养确诊为内源性真菌性眼内炎患者9例（13眼）。方法所有患者进行常规眼科检查，取前房水及玻璃体标本涂片和培养，4例进行血培养。给予局部及全身抗真菌药物治疗，行玻璃体注药（两性霉素B）或（和）玻璃体切除术。观察病变特点及治疗效果。主要指标视力，眼前节、服底表现，跟内液涂片及培养结果。结果男性2例，女性7例，4例双跟患病。平均年龄（38．33±15．49）岁。7例有明确发热史，自发热至出现眼部症状平均（26．43±24．81）天（2～60天）。无眼部外伤和内跟手术史。患者以视力下降、眼前黑影飘动遮挡为主诉。易感危险因素包括侵入性操作、免疫力低下等。临床可有或无典型前葡萄膜炎症表现，玻璃体炎性改变呈现团块状混浊，视网膜和（或）视网膜下黄白色浸润病灶。所有病例玻璃体真菌培养阳性。9／13眼玻璃体注药，10／13眼行玻璃体切除术。8例12眼随访（10．13±7．41）个月，11／12眼眼内炎得到控制，眼球保存，6／12眼视力提高。结论内源性真菌性眼内炎根据病史、危险因素、临床表现以及实验室检查等综合进行诊断。玻璃体切除术取材培养可提高检出率。玻璃体切除术及抗真菌药物治疗可有效控制感染，视力保持或提高。

Clinical features and therapeutic outcomes of endogenous fungal endophthalmitis

Objective To analyze the clinical characteristics, diagnosis and treatment of endogenous fungal endophthalmitis. Design Retrospective case series. Participants 9 patients （13 eyes） with vitreous body culture-proven endogenous fungal endophthalmitis in Beijing Tongren Hospital from 2006 to 2009. Methods All patients completed routine ophthalmic examination. Aqueous humor and vitreous body were smeared and cultured. 4 patients underwent blood culture. All patients received local and systemic anti-fungal drug therapy, and were treated by intravitreal injection （amphotericin B） or （and） vitrectomy. Clinical features and therapeutic outcomes were evaluated. Main Outcome Measure Visual acuity, features of the anterior segment and fundus, results of smear and culture in ocular fluid samples. Results There were 2 males and 7 females patients, aged from 24 to 73 years. 4 patients had bilateral endophthalmitis. 7 patients had fever and it taken 2-60 days for them to appear discomforts after fever. None of them had the history of ocular trauma or intraocular surgery. The major complaints included blurred vision and floaters. Invasive operation, hypoimmunity were its major risk factors. The main clinical manifestations included slow progress, different degree of anterior uveitis, vitreous inflammations, pre-or sub-retinal white cxudates. All patients were vitreous body culture positive. 9/13 eyes were treated by intravitreal injection, and 10/13 eyes received vitrcctomy. In 8 patients （12 eyes） who had complete follow-up of 10.13＋_7.41 months, infection was controlled in 10 eyes, and visual acuity was improved in 6 eyes. Conclusions Synthetic diagnosis and treatment of endogenous fungal endophthalmitis is very important. Vitreous body culture can improve the diagnosis rate. Vitrectomy and anfi-fungal drug therapy can control infection effectively.