青光眼术后滤过泡感染相关眼内炎10例临床分析

Clinical analysis of 10 cases of endophthalmitis associated with filtering blebs infections after glaucoma filtering surgery

目的 探讨青光眼滤过术后滤过泡感染和滤过泡感染相关性眼内炎的发病原因、机制、临床特点、治疗方法及其预后。方法 收集2004年1月—2011年6月间北京同仁医院住院治疗的10例（10眼）青光眼滤过手术后滤过泡感染相关性眼内炎患者的临床资料并进行回顾性分析。包括性别、年龄、术后发病时间、患者全身情况、眼部表现、治疗方法、治疗后眼部情况,以及微生物检查结果。结果 10例眼内炎患者年龄范围4~74岁,平均37.8岁。术后眼内炎发生时间最短为术后1年,最长为术后30年,平均7.4年。伴前房积脓者3例,占30%。合并糖尿病、高血压、心脏病等全身疾病者3例,占30%。1例行眼内容剜除,9例行晶状体玻璃体切除联合硅油填充＋异体巩膜修补＋自体结膜瓣遮盖,其中3例玻切术中联合行玻璃体腔注药术。微生物检查2例阳性,占20%。患者术后视力均有所恢复,1例术后视力最高为0.08,占10.00%;4例患者视力为手动,占40.00%;光感的患者共3例,占30.00%;还有1例不合作,占10.00%;1例无眼球,占10.00%。术后眼压为6~24 mm Hg（1mm Hg=0.133 k Pa）,平均14.87 mm Hg。结论 青光眼滤过术后感染性眼内炎的发生多在术后多年,与薄壁滤过泡或滤过泡瘘关系密切。眼内炎应及早诊断和治疗,手术积极处理可有效控制炎症和眼压,保存有效视力。

Objective To discuss the etiology, mechanism, characteristics, treatment and outcome of glaucoma filtering bleb infections and endophthalmitis associated with tittering blebs. Methods The clinical data of 10 cases（ 10 eyes） of endophthalmitis associated with filtering blebs infection in our hospital from January 2004 to June 2011 were retrospective- ly analyzed. The key indicators included gender, age, time of onset, general condition of patients, eye condition, treatment, eye conditions after the treatment and microbiological examination results. Results All 10 patients aged from 4 to 74 years with an average of 37.8 years. The postoperative endophthalmitis occurred within 1 to 30 years with an average of 7.4 years. 3 patients were with hypopyon（ 30% ）. 3 patients（ 30% ） were with diabetes, hypertension, heart disease or other systemic diseases. 1 case received evisceration,9 cases received the lens vitrectomy ＋ silicone oil tamponade ＋ allogeneic sclera patches ＋ autologous conjunctival flap cover, in which 3 cases undergoing vitrectomy additionally received vitreous cavity injection technique. The microbiological examinations in 2 cases were positive, accounting for 20%. The visual acuity of patients was improved in all patients, 1 cases was 0.08 （10%） ,4 patients could see the examiner＇s hand moving（40% ） ,3 cases were with light perception （ 30% ）, 1 cases is uncooperative （ 10% ）, and 1 case lose eyeball （ 10% ）. The postoperative intraoeular pressure was 6 to 24 mm Hg with an average of 14.87 mm Hg. Conclusion The endophthalmitis associated with filtering blebs infections commonly set on a lot of years after the glaucoma filtration surgery,closely related with thin-wall bleb or bleb leakage. Endophthalmitis should be early diagnosed and well treated. The surgical treatment can effectively control the inflammation and intraocular pressure, and retain effective visual acuty.