儿童外伤性眼内炎的临床疗效分析

Analysis of clinical effect on post-traumatic endophthalmitis in children

目的：探讨儿童外伤性眼内炎的治疗效果。方法：回顾性研究2～11岁儿童确诊为外伤性眼内炎24例24眼的治疗方法及结果。所有患儿入院后立即行患眼的玻璃体腔内注药（万古霉素1mg/0.1mL＋头孢他啶2.25mg/0.1mL＋地塞米松0.4mg/0.1mL）,第2d,23例重症者行玻璃体切除＋晶状体切除术,充填硅油者10例、无菌空气者8例、C3F8者3例、灌注液者2例。1例轻症者72h后再次注射。结果：术后随访6～78mo,所有病例炎症控制,4例眼球萎缩（3例硅油眼）。7例硅油眼已取出硅油并植入IOL。BCVA：〈0.02者12例,0.02～0.1者4例,0.15～0.3者4例,0.5～1.0者4例。16例（70%）较入院视力提高,4例（17%）不变,3例（13%）下降,1例不配合。结论：及时行玻璃体腔内注射广谱抗生素、玻璃体切除术能改善儿童外伤性眼内炎的预后。

AIM ： To analyze the outcome of treating post-traumatic endophthalmitis in children. METHODS： Twenty-four 2 ～ 11 year-old children （24 eyes） with post-traumatic endophthalmitis that presented to our hospital from June 2006 to Feburary 2014 were retrospectively analyzed. All cases were performed intravitreal injection of vancomycin （ ling/0, lmL） and ceftazidime （ 2. 25mg/0. lmL ） and dexamethasone （0.4mg/0. lmL） immediately after being identified. The second day after injection, 23 eyes were received lensectomy and vitrectomy with silicone oil （n= 10） or C3Fs（n=3） or clean air （n=8） or irrigating solution （n=2） tamponade. Onty one eye was reinjected at 72h after the first injection. The visual outcomes were evaluated. RESULTS： After follow-up 6 ～ 78mo, the inflammation of all cases were controled, 4 cases of eyeball atrophy （3 cases of silicone oil eye）. Other 7 silicone oil filled eyes were received silicone oic extraction and IOL implantation. Twelve eyes presented with visual acuity of lower than 0.02, 4 eyes achieved 0.02 ～ 0.1, 4 eyes were 0.15～0.3,only4 eyes reached 0.5～1.0. The final visual acuity improved in 16 eyes （70%）, remained unchanged in 4 eyes （17%） and decreased in 3 eyes （13%）. One case did not fit. CONCLUSION： Early diagnosis of endophthalmitis in open-globe injury, intravitreal injection of antibiotics and vitrectomy can salvage more than a half of injuried eyes in children.