青光眼滤过泡感染及滤过泡相关性眼内炎临床分析

Blebitis, early endophthalmitis,and late endophthalmitis associated with glaucoma filtering blebs

目的了解青光眼滤过手术后滤过泡感染和滤过泡相关性眼内炎的临床特点、危险因素、治疗方法和愈后情况。方法回顾分析1999年1月1日至2004年4月30日我院收治的全部滤过泡感染和滤过泡相关性眼内炎患者的临床资料。结果共收集18例(18只眼)患者的临床资料,其中单纯滤过泡感染6例(6只眼),急性眼内炎4例(4只眼),迟发性眼内炎8例(8只眼)。滤过泡感染和迟发性眼内炎发生时间介于术后1个月余至15年之间,均发生于薄壁滤过泡患者。急性眼内炎发生于术后1个月之内。滤过泡感染的致病菌培养阳性率为50%,以葡萄球菌为主;急性眼内炎致病菌培养阳性率为75%,病原菌为真菌和绿脓杆菌;迟发性眼内炎致病菌培养阳性率为37.5%,病原菌为革兰氏染色阳性球菌、表皮葡萄球菌、大肠杆菌。滤过泡感染患者治疗效果较好,视力均在0.1以上;早期行玻璃体手术联合全身及局部的广谱抗生素治疗可有效控制感染性眼内炎,但多数患者视力低于0.05,真菌或革兰氏阴性菌感染的患者视力预后差。结论薄壁滤过泡与滤过泡感染和迟发性眼内炎的发生关系密切。单纯滤过泡感染的视力愈后好;眼内炎患者的视力愈后与致病菌种类有关,大部分患者视力愈后差。

Objective To evaluate the clinical characteristics, risk factors, causative organisms, treatment methods, and visual acuity outcomes of blebitis and endophthalmitis after glaucoma filtering surgery. Methods The medical records of all patients with blebitis and endophthalmitis after glaucoma filtering surgery treated at Zhongshan Ophthalmic Center between January 1, 1999 and April 30, 2004 were reviewed retrospectively. Results Eighteen patients were identified, including six of blebitis, four of acute endophthalmitis and eight of late endophthalmitis. All cases with blebitis and delayed - onset endophthalmitis had a thin - walled bleb. Conjunctival cultures were performed in all blebitis patients, and there were two cultures with staphylococcus epidermidis, one with staphylococcus aureus. Confirmed microbiologic growth was demonstrated from intraocular specimens from three acute endophthalmitis patients and three late endophthalmitis patients, and the results were different individually. ＇The initial treatment included intravenous and topical antibiotics, a pars plana vitrectomy in 9 endophthalmitis patients. One endophthalmitis patient presented with severe pain and uncontrolled infection was treated by evisceration of eye, Bleb infection responded well to antibiotic treatment with a good visual outcome, while the visual prognosis with endopthalmitis was poor, and only two patients achieved a visual acuity above 20/400. Conclusions Endophthalmitis can occur at any time after glaucoma filtering surgery. Thin-walled blebs are more susceptible to infection. Patients with endophthalmitis had poorer visual outcome than those with blebitis, and visual prognosis was closely related with the causative organisms.