小切口非超声乳化白内障摘除联合人工晶体植入术后感染性眼内炎的临床分析

Clinical analysis of endophthalmitis after small incision non-phacoemulsification cataract surgery and IOL implantation at a primary level hospital

目的探讨基层医院小切口非超声乳化白内障摘除联合人工晶体植入术后感染性眼内炎的危险因素、治疗和预后。方法回顾性分析2005年5月～2010年7月本院收治的8例(8只眼)感染性眼内炎患者的临床资料,分析感染性眼内炎的危险因素、病程、治疗及预后。结果 8例感染性眼内炎患者主要临床表现为眼红痛和视力障碍。8例患者中3只眼接受抗生素等药物综合治疗,4只眼行玻璃体切除、晶状体后囊膜切除及人工晶体取出术联合综合药物治疗,1例行眼球摘除术。6例患者保存了视力,1例眼球萎缩。细菌培养1例为表皮葡萄球菌感染,1例为肺炎链球菌感染。结论糖尿病患者白内障术后感染性眼内炎的发生几率较大,眼外伤、恶性肿瘤也可能是白内障术后眼内炎发生的危险因素,玻璃体手术和规范用药是有效的治疗手段。

Objective To investigate the risk factors for a predisposition to endophthalmitis,clinical features,methods of treatment,and therapeutic outcomes after small incision non-phacoemulsification cataract surgery and IOL implantation at a primary level hospital.Methods Data on 8 patients（8 eyes） with endophthalmitis after cataract extraction and IOL implantation at county and town hospitals between May 2005 and July 2010 were retrospectively reviewed and analyzed with respect to risk factors,clinical manifestations,methods of treatment,and outcomes.Results Clinical features were ocular redness,pain,and decreased vision.The 8 patients had undergone conservative treatment,and endophthalmitis was cured in 3 patients but not in the other 4 patients,who had received vitrectomy and total capsulectomy with IOL explantation and 1 patient who underwent enucleation.Eyesight was maintained in 6 patients,and 1 eye atrophied.Bacterial cultures revealed Staphylococcus epidermidis in 1 patient＇s vitreous humor and Streptococcus pneumoniae in 1 patient.Conclusion Underlying diseases such as diabetes,ocular trauma,or malignancy were risk factors for endophthalmitis after cataract extraction and IOL implantation.Vitrectomy together with antibiotics and general and local use of corticosteroids were effective in treating endophthalmitis.