内源性眼内炎的病因及疗效分析

Risk factors, causes and treatment outcomes of endogenous endophthalmitis

目的分析内源性眼内炎的病因、全身易感因素、治疗及预后。方法回顾分析近5年内11例内源性眼内炎患者的全身状况及眼部情况，玻璃体液培养结果，治疗方法和预后。结果11例内源性眼内炎患者中8例（72．7％）有全身易感因素，其中肝脓肿3例（27．3％），肝移植术后1例（9．1％），肾移植术后1例（9．1％），肺炎1例（9．1％），糖尿病1例（9．1％），皮肤真菌感染1例（9．1％）。11例患者均行玻璃体液细菌、真菌培养和药敏试验，阳性9例（81．8％）。其中细菌6例（66．7％），真菌3例（33．3％）。9例患者接受玻璃体切除术及全身治疗，2例患者接受眼内注药及全身治疗。最终7例（63．6％）患者视力有不同程度提高，2例（18．2％）行眼球摘除术，2例（18．2％）眼球萎缩。结论内源性眼内炎的患者大部分有全身易感因素，早期诊断，有效地抗炎抗感染治疗，及时行玻璃体注药和（或）玻璃体切除术，可挽救大部分患者的视力。

Objective To investigate etiology, risk factors, treatment strategy and prognosis of en- dogenous endophthalmitis. Methods This study included 11 eyes of 11 patients diagnosed with en- dogenous endophthalmitis and treated at the First Affiliated Hospital, Zhejiang University from 2007 to 2010 were retrospectively reviewed. Features studied included patients＇ systemic predisposing fac- tors, culture results of vitreous, treatments and prognosis. Results For the 11 cases of endogenous endophthalmitis, there were 8 patients who had risk factors, including liver abscess in 3 cases （27.3%）, 1 case （9.1%） after liver transplantation, 1 case （9.1%） after renal transplantation （9.1%）, 1 case （9.1%） was pneumonia, 1 case （9.1%） was diabetic patient （9.1%）, 1 case （9.1%） was fungal skin infection. All the patients underwent vitreous bacterial, ffmgal culture and susceptibility testing, there were 9 （81.8%） positive cases for vitreous culture, in which 6 cases （66.7%） for bacterium and 3 cases （33.3%） for fungus. Nine patients received vitrectomy and systemic therapy, 2 patients received intraocular injection and systemic therapy. Finally, there were 7 （78%） eyes with improved visual acuity, 2 （18%） eyes were atrophy, and 2 （18%） eyes eviscerated or enucleated. Conclusions Most of the patients with endogenous endophthalmitis have systemic predisposing factors, early diag- nosis, and effective anti-inflammatory and anti-infection treatment, line the vitreous injection and / or vitrectomy surgery in a timely manner, can save most of the patient＇s vision.