白内障超声乳化联合人工晶状体植入术后霉菌性眼内炎

Clinical analysis of fungal endophthalmitis after cataract phacoemulsification and intraocular lens implantation

目的:探讨白内障术后霉菌性眼内炎的发病过程及临床表现,希望有助于临床医师对该疾病的认识。方法:回顾性分析近年来我院5例白内障超声乳化联合人工晶状体植入术后发生霉菌性眼内炎的发病经过、临床表现、诊断治疗及预后等情况。5例于白内障术后30～50d确诊眼内炎后均急诊行前房冲洗、玻璃体切除硅油填充术。并于玻璃体切除术后局部及全身使用抗真菌类药物。结果:有2例行眼内容剜除术,3例术后3mo随访见眼球轻度萎缩,视力分别为光感和指数/眼前。结论:对内眼手术即使是眼前节手术术后迟发型眼内炎症反应或经正规抗生素、激素治疗病情反复者应想到有真菌感染的可能,及时抽取标本作细菌、真菌涂片、培养及药物敏感试验,争取能够早期诊断和治疗,最大限度保留有用视力和眼球。

AIM： To discuss the development and clinical features of fungal endophthalmitis after cataract operation, which will be helpful for clinicians aknowledge the desease. METHODS： We retrospectively analyzed 5 cases of fungal endophthalmitis after phacoemulsification and intraocular lens implantation. The course, clinical features, diagnosis, treatment and prognosis were discussed. Five cases were emergency performed the anterior chamber irrigation and vitrectomy and silicone oiltamponate when diagnosed as endophthalmitis. Antifugal agent were locally and systematically used after the operation. RESULTS： Two cases were performed evisceration of eyeball, 3 cases showed mild phthisis bulbi 3 months postoperation with poor vision. CONCLUSION： Fungal infection should be considered when delayed endophtholmitis appears or the symptoms repeat with regular usage of antibiotic and hormone after intraocular operation even anterior segment surgery. It＇s necessary to withdraw specimens for bacteria and fungus culture and drug sensitivity test in time to try for earlier diagnosis and treatment.