19例内源性眼内炎患者的临床特征分析

The clinical features of 19 endogenous endophthalmitis cases

目的探讨内源性眼内炎的病因及病原学特征、视功能的预后情况。方法采用回顾性系列病例研究。收集2009年至2016年就诊于复旦大学附属中山医院和华山医院眼科的19例23眼内源性眼内炎的患者资料，研究内源性眼内炎的主要危险因素、微生物培养结果、诊疗方案及视功能预后情况。结果本研究纳入患者19例23眼，其中女7例8眼，男12例15眼；年龄24～85岁，平均（54.0±17.9）岁。患者常合并其他较严重的基础疾病，其中以糖尿病（9/19）及肝脓肿（8/19）为主。玻璃体培养17例20眼，其中微生物培养阳性10例12眼，阳性率为12/20。血液或其他体液培养15例，微生物培养阳性10例，阳性率为10/15。真菌性眼内炎致病菌以白念珠菌为主（5/6），细菌性眼内炎以肺炎克雷伯菌为主（7/13）。主要治疗方法为玻璃体切除、玻璃体注射及全身和局部抗菌药物治疗，仅5眼视力改善；6眼行眼内容物剜除或眼球摘除。从发病至眼科就诊在1周内的8例10眼，视力改善3例5眼（5/10），视力无变化1例1眼，无光感或眼内容物剜除4例4眼。而发病至专科就诊〉1周者视力均无改善。结论内源性眼内炎虽然发病率低，但是预后极差，及时诊治有利于最大限度地挽回视功能。

ObjectiveTo investigate the etiological features and visual outcomes of endogenous endophthalmitis （EE）.MethodsA retrospective consecutive case series of 19 patients （23 eyes） presenting with presumed EE from 2009 to 2016 in the Ophthalmology Department of Zhongshan Hospital and Huashan Hospital, Fudan University were included. Patients′ medical history （main risk factors）, microbial culture results, treatment regimen and visual outcomes were evaluated.ResultsIn total, 19 patients （23 eyes） were identified, including 7 female （8 eyes） and 12 male （15 eyes）. Mean age was 54.0±17.9, ranging from 24 to 85. Most patients had severe underlying diseases, mainly diabetic mellitus （9/19） and liver abscess （8/19）. Twenty vitreous samples from 17 cases were cultured, and 12 eyes from 10 cases were positive with a positive rate of 12/20. Fifteen cases had blood or body fluids cultures and 10 were positive, with the positivity rate of 10/15. Candida albicans （5/6） was the most common pathogen isolated in fungal endophthalmitis, and Klebsiella pneumonia （7/13） was the most common pathogen in bacterial endophthalmitis. Patients mainly received vitrectomy, intravitreal injection, and systemic/local antibiotic therapy. Only five eyes had improved visual acuities, and 6 eyes were enucleated or eviscerated.Among the 10 eyes from 8 cases who were treated within one week after onset, 5 eyes from 3 cases （5/10） had improved visual acuities; one eye from one case had no visual improvement; four eyes from four cases had no light perception or enucleated. No improved visual acuity occurred in patients who were treated after one week.ConclusionsAlthough the incidence is low, EE has poor visual outcomes. Timely diagnosis and treatment may be helpful to maximize the recovery of vision.