白内障术后细菌性眼内炎的早期诊断和治疗

Early diagnosis and treatment of infective endophthalmitis after cataract surgery

目的探讨白内障术后细菌性眼内炎的早期诊断和治疗。方法分析2012年8月至2013年2月期间本院及合作中心白内障超声乳化术后7例（7眼）细菌性眼内炎的临床表现、诊断和治疗以及预后情况。结果 6眼眼内炎早期表现不典型：仅有突发性前房炎症反映,而无眼痛、明显视力下降及充血、结膜水肿,无或仅有少量前房积脓、无玻璃体积脓,但1-2 d后眼内炎症快速发展：前房炎症反应加重、玻璃体出现积脓;1眼早期即有急剧视力下降、明显眼痛及前房、玻璃体积脓的典型表现。4眼经球内抗生素注射、3眼行玻璃体切割联合人工晶状体取出术后炎症控制。微生物培养结果（7眼）：2眼为表皮葡萄球菌,1眼为粪肠球菌,4眼阴性。随访视力均有提高,最高达0.5。结论白内障术后出现突发性前房渗出性炎症,即便无眼痛及明显充血、视力下降者,仍需高度警惕细菌性眼内炎。早期诊断、及时治疗与病原学检查显得尤为重要,否则一旦炎症加重则错过最佳治疗时机、导致不可逆盲甚至眼球丧失。

Objective To discuss the early diagnosis and treatment of bacteria endophthalmitis after cataract surgery. Methods It was a retrospective case series study. Seven eyes in 7 patients were studied retrospectively including the clinical findings,diagnosis,treatment and prognosis,with bacteria endophthalmitis after phacoemulsification in our hospital and cooperation center from August 2 0 1 2 to February 2 0 1 3. R esults The clinical manifestations of 6 patients were atypical,only with paroxysmal anterior formability inflammation in the first 3- 6 days,but without eye pain,obvious decreased vision and hyperemia,conjunctival edema,and without or with little atrial empyema,and vitrea empyema. But the diseases progressed quick including aggravated intraocular inflammation and vitrea empyema in the following 1- 2 days. One eye began with apparent impaired vision,pain,anterior chamber empyema and vitreal empyema. Four eyes were cured after intravitreal administration of antibiotics and 3 eyes after vitrectomy combined with intraocular lens extraction. Cuticle staphylococcus was cultured positive in 2 eyes,enterococcus faecalis was cultured positive in 1 eye,and negative findings were cultured in 4 eyes. The final visual acuity increased in 7 eyes at the end of follow-up time,with the best as 0.5. C onclusion Any sudden anterior chamber exudative inflammation after cataract surgery,but no eye pain and obvious congestion,decreased vision,need to be highly vigilant bacterial endophthalmitis. Early diagnosis,timely treatrment and etiolog examination are very important,otherwise bacteria endophthalmitis after cataract surgery is easy to miss the optimal therapy opportunity,then result in uncurable blindness and even loss of the eye.