外伤性枯草杆菌性眼内炎临床分析

A retrospective review of twenty-two cases with traumatic endophthalmitis caused by bacillus subtilis

目的：总结外伤性枯草杆菌性眼内炎的临床特征，探讨早期诊治的措施。方法：回顾性总结分析2003年1月至2013年12月中山大学中山眼科中心眼外伤科收治的枯草杆菌性眼内炎的22例（22眼）患者的临床资料。结果：22例患者，合并眼内异物存留15例，角膜浸润15例，眼眶蜂窝组织炎7例。接受伤口缝合眼内抗生素注射7例，单纯玻璃体手术7例，玻璃体手术联合硅油填充8例。11例无光感．11例光感～0．05，3例眼内容剜除。22株枯草杆菌菌株对妥布霉素、庆大霉素、头孢哌酮、左氧氟沙星及氧氟沙星敏感。年龄、角膜浸润和眼内异物存留是枯草杆菌眼内炎预后不良的危险因素（P〈0．05）．硅油填充是预后较好的保护因素（P〈0．05）。结论：以角膜伤口为中心的环状浸润，前房脓血样积液是枯草杆菌眼内炎的典型体征。庆大霉素、妥布霉素、头孢哌酮、左氧氟沙星和氧氟沙星是治疗枯草杆菌眼内炎有效抗生素，及早进行玻璃体手术联合硅油填充是挽救视功能最有效的方法。

Objective To study the clinical features and investigate the early diagnosis and treatment of traumatic endophthalmitis caused by bacillus subtilis. Methods In this study, the clinical and laboratory data of twenty-two cases （22 eyes） with traumatic endophthalmitis caused by bacillus subtilis treated at Zhongshan Ophthalmic Center, Sun Yat-sen University between January, 2003 and December, 2013 have been summarized. Results In these 22 cases, 15 cases were combined with intraocular foreign bodies, 15 cases with corneal infiltration and 7 cases with orbital cellulitis. The surgical procedures of the patients included wound suture and intraocular injection of antibiotics （7 cases）, vitrectomy alone （15 cases） and vitrectomy with silicone oil tamponade （8 cases）. The outcome of treatment was 11 cases without light perception, 11 cases with light perception to 0.05 and 3 cases with evisceration. The bacillus subtilis strains of these 22 cases were sensitive to tobramycin, gentamycin, cefoperazone, levofloxacin and ofloxacin. Age, corneal infiltration and intraocular foreign bodies were the risk factors affecting prognosis （P 〈 0.05） of traumatic endophthalmitis while silicone oil tamponade was confirmed to be the protecting factor （P 〈 0.05）. Conclusions Sanguinopurulent anterior chamber effusion and ring infiltration surrounding the cornea wounds are the typical signs of traumatic endophthalmitis caused by bacillus subtilis. Gentamycin, tobramycin, cefoperazone, levofloxacin and ofloxacin are effective antibiotics against bacillus subtilis. Once the diagnosis is made, vitrectomy combined with silicone oil tamponade is an optimal treatment to save visual acuity, which should be done as soon as possible.