内源性白色念珠菌性眼内炎的临床表现和治疗分析

Clinical features and therapeutic outcomes of endogenous candida albicans endophthalmitis

目的观察内源性白色念珠菌性眼内炎的临床特征．探讨其易感因素和治疗效果。方法回顾性病例系列研究。分析11例经玻璃体标本培养确诊的内源性白色念珠菌性眼内炎患者18只跟的临床资料，着重分析其易感因素、临床表现和治疗方法及效果。患者中男性4例，女性7例；其中7例患者双眼患病。年龄19至72岁，平均年龄（41．61±9．76）岁；人工流产手术后2例，接受静脉输液3例，结肠癌手术后1例，结肠淋巴瘤手术后复发，化学药物治疗中1例，肾移植手术后1例，急性坏死胰腺炎手术后1例，糖尿病1例，无明确过去病史者1例。所有患者均无眼部外伤和内眼手术史。18只眼中，11只眼接受玻璃体手术治疗，7只眼接受玻璃体腔注射抗真菌药物，10例患者接受全身抗真菌药物治疗。结果患者均以视力下降、视物变形或眼前漂浮物为主要就诊原因；出现症状至就诊时间3～38d，平均时间（15．23±8．70）d。视网膜面或视网膜下白色团块渗出合并玻璃体炎性改变为主要临床表现。除1例外，炎症均通过玻璃体手术或玻璃体腔注射抗真菌药物得以控制。大部分患者视力提高。结论视网膜面或视网膜下白色团块渗出合并玻璃体炎性改变为内源性白色念珠菌跟内炎的特征性眼底表现；不规范静脉输液、人工流产及患恶性肿瘤为本组患者致病的高危因素；玻璃体手术或注抗真菌药物治疗有效。

Objective To evaluate the clinical features, risk factors and treatment outcomes of endogenous eandida albicans endophthalmitis. Methods The clinical data of 11 patients （18 eyes） with vitreous specimen culture-proven endogenous eandida endophthalmitis were retrospective reviewed, including risk factors, clinical features and therapeutic methods and outcomes. Results There were 4 males and 7 females patients, aged from 19 to 72 years with a mean age of （41.61 ± 9.76）years. Seven patients had bilateral endophthalmitis. They had histories of induced abortion （2 patients）, intravenous transfusion （3 patients）, colon cancer surgery （1 patient）, chemotherapy after surgery of malignant lymphoma of colon （1 patient）, renal transplantation （1 patient）, acute necrotic pancreatitis surgery （1 patient） and diabetes （1 patient）. One patient has no special medical history. All patients had no history of ocular trauma or intraocular surgery. The major complaints included blurred vision, metamorphopsia and floaters. It taken an averageof （15.23±8.70） days （3-38 days） for patients to go to the hospital after getting those symptoms. The main clinical manifestations included pre- or sub-retinal white exudates and vitreous inflammations. In 18 eyes, 11 received vitreous surgery, and the other 7 were treated by intravitreal administration of anti fungal drugs. Ten patients also underwent systemic anti-fungal therapy. The eandida endophthalmitis was cured for 10/11 patients and most of them with increased visual acuity. Conclusions Endogenous eandida albicans endophthalmitis is characterized by pre or sub retinal white exudates and vitreous inflammations. Non-standard intravenous transfusion, induced abortion and malignancy are its major risk factors. Pars plana vitrectomy or intravitreal delivery of anti-fungal drugs can cure this disease.