眼内异物伤眼内炎的临床观察

目的:探讨眼内异物伤眼内炎的感染因素、诊治情况.方法:收集256例眼内异物伤中42例发生眼内炎病例,从致病因素、微生物学检测及诊断治疗进行回顾性分析.结果:眼内异物伤眼内炎发生率为16.4%.眼后节异物及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素(P＜0.05).眼内异物伤Ⅰ期给予玻璃体腔注射盐酸去甲万古霉素及头孢他啶可以减少眼内炎的发生率(P<0.05).异物性质及大小、取出时间及伤口情况对眼内炎发生率无明显影响(P＞0.05).眼内异物伤眼内炎手术分级Ⅲ级最多.玻璃体切除手术是治疗眼内炎的主要手术方式.结论:眼后节异物伤及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素,Ⅰ期手术需处理白内障时尽量保留完整的晶状体后囊膜.建议眼后节异物伤Ⅰ期行玻璃体腔注射万古霉素及头孢他啶.一旦确诊眼内炎,尽早进行玻璃体切除手术.

Clinical observation of endophthalmitis caused by intraocular foreign body injury

AIM: To investigate the infection factors, diagnosis and treatment of endophthalmitis after intraocular foreign body injury.

METHODS: Totally 256 cases with intraocular foreign bodies including the occurrence of endophthalmitis in 42 cases were analyzed retrospectively.

RESULTS: The incidence of endophthalmitis after intraocular foreign body injury was 16.4%. Posterior segment foreign bodies and combined with traumatic cataract were the risk factors of endophthalmitis after intraocular foreign body injury(all P<0.05). Intravitreal injection of vancomycin hydrochloride and ceftazidime in the treatment of intraocular foreign body injury reduced the incidence of endophthalmitis(P<0.05). Types and sizes of intraocular foreign bodies,the time of extraction and the condition of wound had no significant effect on the incidence of endophthalmitis(all P>0.05). Vitrectomy was the main treatment of endophthalmitis.

CONCLUSION: Posterior segment foreign bodies and combined with traumatic cataract were the risk factors of endophthalmitis after intraocular foreign body injury. It should be kept the integrity of the posterior capsule of lens in traumatic cataract surgery. Intravitreal injection of vancomycin and ceftazidime is recommended in emergency surgery. Vitrectomy should be performed as soon as possible when confirmed endophthalmitis.