内源性眼内炎临床特征及手术治疗效果

Clinical characteristics and surgical efficacy of endogenous endophthalmitis

目的评价内源性眼内炎玻璃体切除术的治疗效果。方法对2014年8月至2017年8月内源性眼内炎12例（12只眼）的临床特征、手术治疗及其效果进行回顾性分析。结果患者年龄32～75岁，平均（53．67±3．09）岁，男8例（66．67％），女4例（33．3％）。右眼8例（66．67％），左眼4例（33．3％）。9例（75．00％）伴全身疾病，5例（41．67％）玻璃体培养得到阳性结果，2例首次就诊时误诊为非感染性葡萄膜炎。所有患者均行玻璃体切除术，术中硅油填充。术后10只眼（83．33％）感染得到控制，2只眼（16．67％）因感染复发最终行眼内容摘除术。9只眼（75．00％）视力较治疗前提高，7只眼视力数指-0．3，其中1只眼白色念珠菌感染者获得最好视力。结论内源性眼内炎患者常存在全身易感因素，临床表现缺乏特异性，且视力结局较差。药物治疗基础上施行玻璃体切除术，术中填充硅油可有效控制感染，获得较好治疗效果。

Objective To evaluate the efficacy of vitrectomy for the treatment of endogenous endophthalmitis. Methods The data of 12 eyes of 12 cases with endogenous endophthalmitis from Aug. 2014 to Aug. 2017 were collected. The clinical characteristics, surgery treatment and its efficacy were retrospectively analyzed. Results The age of 12 patients ranged from 32 to 75 years, average （ 53.67±3.09） years. There were 8 （66.67%） males and 4 （33.3 % ） females. Eight cases （66.67%） were right eyes and 4 cases （ 33.33% ） were left eyes. Endogenous endophthalmitis with systemic disease was in 9 patients （75.00%） ,positive culture outcome happened in 5 cases （41.67%）, 2 eyes were misinterpreted as non-infectious uveitis at first visit. All cases underwent pars plana vitrectomy （PPV） combined with silicone oil tamponade. The infection was controlled after surgery in 10 eyes （ 83. 33% ） and 2 eyes （16.67%） received evisceration of eyeball due to recurrent infection. After surgery, visual acuity was from counting fingure to 0.3 in 7 eyes. One eyes infected by Candida got the best vision acuity. Conclusion The patients with endogenous endophthalmitis generally have systemic predisposing factors. There is no specific clinical feature and the prognosis of visual acuity is poor. Antibiotic therapy and vitrectomy combined with silicone oil tamponade can control infection effectively and achieve better efficacy.