玻璃体切割并晶状体切除硅油填充术治疗重度外源性眼内炎

Vitrectomy combined with lensectomy, silicone oil tamponade for severe exogenous endophthalmitis

目的观察玻璃体切割联合晶状体切除、硅油填充术治疗重度外源性眼内炎的效果。方法对2009年6月至2012年12月在聊城市医院眼科就诊的28例（28只眼）重度外源性眼内炎患者的临床资料进行回顾性分析。所有患者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。28只眼进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12—36个月，观察分析手术前后眼球保留情况、视力和眼压改善情况。结果28只眼中，手术后炎症控制，保留眼球者27只眼，占96．43％（27/28）。27只患眼中，24只眼视力提高，占88．89％（24／27）；2只眼视力不变，占7．41％（2／27）；1只眼视力下降，占3．70％（1／27），术后1、12个月视力与术前视力相比较，差异有统计学意义（Z=34．11，P〈0．01）。术后眼压较手术前降低，差异有统计学意义（r=7．42，P〈O．05）。28分玻璃体标本中，培养结果阳性者11例，检出率为39．29％（11／28）。结论玻璃体切割联合晶状体切除、硅油填充术是治疗重度外源性眼内炎的有效方法，术后并发症主要是增生性玻璃体视网膜病变和视网膜脱离。

Objective To observe the effect of vitrectomy combined with lensectomy, silicone oil tamponade for severe exogenous endophthalmitis. Methods The clinical data of 28 patients （28 eyes） with severe exogenous endophthalmitis were analyzed retrospectively. All patients diagnosed by best corrected visual acuity, intraocular pressure, slitlamp microscopy, direct and indirect ophthalmo scope examination and intraocular Bultrasound examination. Surgery （vitrectomy, lensectomy, silicone oil tamponade） was performed in all 28 patients. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. The followup was 12 to 36 months. The preoperative and postoperative visual acuity, intraocular pressure and eye retention situation were observed. Results Endophthalmitis was controlled in 27/28 eyes （96.43%） after surgery, The visual acuity improved significantly at 1 month and 12 months after surgery （P 〈0.01）. Condusions Vitrec tomy combined with lensectomy, silicone oil tamponade is effective for severe exogenous endophthal mitis. The major postoperative complications are proliferative vitreoretinopathy and retina detachment.