急症玻璃体切割联合晶状体切除、硅油填充手术治疗内源性眼内炎

Emergent vitrectomy combined with lensectomy, silicone oil temponade for endogenous endophthalmitis

目的 观察急症玻璃体切割联合晶状体切除、硅油填充手术治疗内源性眼内炎的效果.方法 对28例内源性眼内炎患者30只眼的临床资料进行回顾性分析.所有患者均无眼部外伤史和内眼手术史.就诊时无全身症状者21例;发热者3例;眼胀痛伴头痛者2例;腹部疼痛者2例.均进行最佳矫正视力、眼压、裂隙灯显微镜、直接和间接检眼镜检查及眼B型超声检查后确诊.无发热、全身情况暂时稳定患者25只眼明确诊断后急症进行玻璃体切割联合晶状体切除、硅油填充术治疗;全身情况不稳定同时有发热或腹痛患者5只眼经相关科室治疗后立即行玻璃体切割联合晶状体切除、硅油填充手术治疗.所有患者治疗前均常规抽取玻璃体积脓送细菌培养加药物敏感试验及真菌培养加药物敏感试验.手术后随访18～30个月,观察分析手术前后视力、眼压改善情况及眼球保留情况.结果 30只眼中,手术后炎症控制,保留眼球者28只眼,占93.3%;手术后玻璃体再次积脓,眼压不能控制,行眼内容剜除手术者2只眼,占6.7%.手术后1、18个月视力与手术前视力比较,差异有统计学意义（x2=19.87,32.44;P＜0.01）.手术后眼压正常者24只眼,占80.0%;出现一过性眼压升高者6只眼,占20.0%.一过性高眼压者经治疗后眼压控制在正常范围,与手术前眼压比较,差异有统计学意义（x2=7.43;P＜0.05）.28份玻璃体标本中,培养结果阳性者12例,致病病原体检出率为42.9%.其中,细菌7例,占培养结果阳性者58.3%;真菌5例,占培养结果阳性者41.7%.28例患者中,合并肝胆系统感染者18例,占64.3%.结论 急症玻璃体切割联合晶状体切除、硅油填充手术是治疗内源性眼内炎的有效方法.

Objective To observe the effect of emergent vitrectomy combined with lensectomy,silicone oil temponade for endogenous endophthalmitis. Methods The clinical data of 28 patients （30 eyes）with endogenous endophthalmitis were analyzed retrospectively. All patients had no history of ocular trauma and intraocular surgery history. There were 21 patients without systemic symptoms, three patients with fever, two patients with eye pain and headache, and two patients with abdominal pain when presentation.All patients diagnosed by best corrected visual acuity, intraocular pressure, slit-lamp microscopy, direct and indirect ophthalmoscope examination and intraocular B-ultrasound examination. Emergent surgery （vitrectomy, lensectomy, silicone oil temponade） was performed in all 30 patients, those with fever or abdominal pain was also treated by relevant clinical departments. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The follow-up was 18 to 30 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed. Results Endophthalmitis was controlled in 28/30 eyes （93.3%） after surgery, recurrent vitreous empyema occurred in 2/30 eyes （6.7%）. Evisceration was performed on those two eyes as uncontrolled intraocular pressure. The visual acuity improved significantly at one month and 18 months after surgery （x2 = 19.87, 32. 44; P 〈 0.01）. Postoperative intraocular pressure was normal in 24 eyes （80.0%）, transient elevated and controlled in six eyes （x2 = 7.43; P〈0. 05）. 12/28 （42.9%） vitreous samples were positive for pathogen culture, including 7/12 （58. 3%） positive for bacteria, 5/12 （41.7%）positive for fungi. There are 18/28 patients （64.3%） also had hepatobiliary system infections. Conclusion Emergent vitrectomy combined with lensectomy, silicone oil temponade is effective for endogenous endophthalmitis.