白内障人工晶体植入术后眼内感染的临床观察

Clinical observation of endophthalmitis after cataract intraocular lens implantation

目的探讨白内障超声乳化吸除联合人工晶体植入术眼内炎的有效预防和治疗方法,以提高手术治愈率。方法回顾性分析2002-2012年2781例(3984眼)患者临床资料,其中仅3例(3眼)患者术后并发眼内感染,对该3眼行细菌学培养和药敏试验,抗菌药物冲洗前房及玻璃体腔,全身应用万古霉素联合头孢类,必要时切除受累玻璃体,随访6个月。结果 3例发生眼内感染患者检出细菌分别为表皮葡萄球菌2株、大肠埃希菌1株;其中2例患者经药物治疗1周后眼内炎得到有效控制,1例表皮葡萄球菌感染患者药物治疗效果较差,行受累玻璃体切除后患眼炎症得到控制,随访复查治疗效果较好。结论眼内炎早期应用抗菌药物可得到有效控制,严重者可采用玻璃体切除术。

OBJECTIVE To study the cataract phacoemulsification and intraocular lens implantation so as to effectively prevent and treat the endophthalmitis so as to improve the surgical cure rate. METHODS The elinicdl data of 2781 patients （3984 eyes） who were treated in the hospital from 2002 to 2012 were retrospectively analyzed, among which there were only 3 cases （3 eyes） with postoperative endophthalmitis. All the three eyes were performed for the bacterial culture and the drug susceptibility testing, and the antibiotics were used to rinse the anterior chamber and vitreous cavity. The vancomycin and cephalosporin were used systemically. The vitrectomy was performed when necessary ,and 6-month follow-up was implemented. RESULTS The endophthaemitis occured in 3 cases. There were 2 cases with Staphylococcus epidermidis infections and 1 case with Escherichia coli infection. Totally 2 cases were effectively controlled after one week treatment with antibiotics, the therapeutic effect was bad on one case with S. aureus infection , and the endophthalmitis was controlled after the vitrectomy. The review of the follow-up indicated that the treatment effect was good. CONCLUSION The endophthalmitis can be effectively controlled in the early stage by using antibiotics, vitreetomy is recommended for the patients with server endophthalmitis.