穿孔伤性白内障伴眼内局限性感染的手术治疗

The surgical treatment for perforating cataract with localized intraocular infection

目的 探讨穿孔伤性白内障伴有眼内局限性感染的治疗时机及治疗方案。方法 回顾性分析 10例 10眼的致伤物、就诊时间、临床表现 ,确定手术及术后治疗方案。结果 4眼前房有轻度炎症 ,10眼局部均有与角膜创口相对应处的虹膜后粘连 ,术中发现虹膜后表面有白色斑片状膜样物 ,晶状体前囊及前皮质呈颗粒状灰白色浑浊。涂片 7眼见真菌孢子或菌丝 ,3眼细菌 ;培养 2眼有镰刀杆菌生长。随访时间 9月～ 2年 ,无复发。结论 钝性物致伤后的穿孔伤性白内障 ,应细致观察虹膜晶状体 (尤其是伤道处 )的表现 ,警惕感染的可能 ,应常规作涂片和培养 ,彻底清除可疑病灶。不宜一期植入人工晶状体。

Objective To discuss the operation time and scheme of treatment for perforating cataract with localized infection.Methods A retrodpective analysis was conducted on 10 eyes perforating cataract with localized intraocular infection,which included the traumatic foreign body,consulting time,clinical manifestation,and treatment medhods.Results During operation,local posterior synechiae near the wound,patched exudative membrane on the posterior surface of the iris and granular gray-white opacity in anterior capsule and anterior cortex of lens were found in all the 10 eyes. There were mild anterior chamber inflammation in 4 eyes. Hypha or spore were found in 7 eyes with smear,the other 3 eyes were found bacterium. Fusarium culture positive were found in 2 eyes. The follow up time was from 9 to 24 months. There were no reoccurrence of fungi or bacterium in all the eyes during the follow up time.Conclusion The surface of iris and 'lens(especially the tunnel of the perforation) should be carefully observed with perforating cataract after blunt trauma. To aware the possible infection,the suspicious focus should be cleaned completely and the experiment examination included smear and microorganism culture should be done during the operation. It is not appropriate to implant intraocular lens combined with the extraction of the cataract.