外因性眼内炎病因及治疗分析

The analysis of the etiological factors and the treatment methods of exogenous endophthalmitis

目的 探讨外因性眼内炎的病因、临床治疗方法.方法 对本院2006年8月至2013年12月外因性眼内炎患者的临床资料进行回顾性分析,并与本院前期的研究结果对比.共116例（116只眼）,年龄18～90岁,平均（48.16 ±15.56）岁.男77例,女39例.95.69％（111只眼）患者采取玻璃体切除及玻璃体内注药方法治疗.随访1～12个月.结果 眼球穿孔伤导致的眼内炎83只眼,白内障手术后感染24只眼,抗青光眼术后滤过泡感染5只眼,玻璃体切除术后感染2只眼,角膜溃疡穿孔继发感染2只眼.与我院前期同类研究的结果对比：革兰氏阳性球菌48例,占87.27％,所占比例上升;革兰氏阳性杆菌3例,占5.45％;革兰氏阴性杆菌4例,占7.27％,所占比例均下降.经玻璃体切除及玻璃体内注药治疗后,视力≥0.02者91例,占78.45％;视力≥0.3者38例,占32.76％.结论 眼球穿孔伤及白内障手术仍是外因性眼内炎的主要致病原因,表皮葡萄球菌是其主要致病菌.玻璃体切除术及玻璃体内注药治疗外因性眼内炎有效.

Objective To investigate the etiological factors and treatment methods of exogenous endophthalmitis.Methods Data of all cases of infectious endophthalmitis treated between August 2006 and December 2013 were reviewed retrospectively and compared with our earlier published report.One hundred and sixteen eyes of 116 cases aged from 18 to 90 years with mean （48.16 ± 15.56） years were enrolled,including 77 male and 39 female patients.95.69% cases accepted vitrectomy and intravitreal antibiotics injection.The follow-up period was from 1 to 12 months.Results Endophthalmitis was in 83 eyes（71.55%） caused by penetrating injury,in 24 eyes （20.69%） caused by cataract surgery,in 5 eyes （4.31%） caused by anti-glaucoma surgery,in 2 eyes （1.72%） caused by vitrectomy and in 2 eyes（1.72%）caused by corneal ulcer perforation.Compared with our earlier report.the percentage of Gram-positive cocci isolates increased which occurred in 48 eyes accounting for 87.27%,while the percentage of the Gram-positive bacilli isolates was 5.45% which occurred in 3eyes and the percentage of Gram-negative bacilli isolates was 7.27% which occurred in 4eyes,both of which decreased.After vitrectomy and intravitreal antibiotics injection,postoperative visual acuity were ≥0.02 in 91 eyes（78.45%） and ≥0.3 in 38 eyes（32.76%）.Conclusion Penetrating ocular injury and cataract surgery are the most common causes of infective endophthalmitis.Staphylococcus epidermidis was the predominant pathogen.Combined vitrectomy and intravitreal antibiotics injection was an effective treatment for endophthalmitis.