青光眼术后滤过泡相关性眼内炎临床及病原菌分析

Analysis of clinical and pathogenic bacteria of bleb associated endophthalmitis after glaucoma surgery

目的观察青光眼术后滤过泡相关性眼内炎的临床特征、致病菌及药敏。方法回顾性分析2011年1月至2017年6月诊治的青光眼小梁切除术后的滤泡相关性眼内炎28例（28只眼），记录其发病年龄、眼内炎发病至手术时间及治疗后视力，采集房水及玻璃体标本行微生物培养及药敏试验。结果眼内炎发生时间为末次术后16d-16年，平均为（54．2±39．1）个月。其中有11只眼病原菌培养阳性，阳性率为42．3％。链球菌与葡萄球菌为主要致病菌，均对万古霉素敏感。经玻璃体内注射抗生素和（或）玻璃体切除术，25只眼（89．3％）炎症控制。治疗后10只眼（35．7％）视力达0．05及以上，8只眼（28．6％）无光感，有3例（10．7％）行眼球摘除术。结论滤过泡相关性眼内炎多为迟发性，链球菌和葡萄球菌是最常见的致病菌。玻璃体切除术能有效控制眼内炎，尽管成功地治疗了感染，但视力结果较差。

Objective To observe the clinical features, pathogenic bacteria distribution and drug sensitivity of bleb-related endophthalmitis after trabeculectomy. Methods The data of 28 eyes of 28 cases with bleb-associated endophthalmitis after trabeculectomy from Jan. 2011 to Jun. 2017 were analyzed retrospectively. The age of onset, duration of endophthalmitis to operation and visual acuity were recorded. The samples of aqueous humor and vitreous were sent to microbiological cuht re and drug sensitivity test. Results The average occurrence time of endophthalmitis was 16 d - 16 years, average （ 54.2 ±39.1 ） months after the last operation. The samples were positive to the bacteria culture in 11 eyes. The positive rate of bacteria was 42.3%. Streptococcus and Staphylococcus were the main pathogenic bacteria. Streptococcus and Staphylococcus were sensitive to Vancomyein. Inflammation was controlled after intravitreal injection of antibiobics or vitrectomy in 25 eyes （ 89.3 % ）. The visual acuity ≥ 0.05 was in 10 eyes（35.7% ）. There were 8 eyes （28.6%） with no light perception. Three cases （10.7%） eventually underwent enucleation of eyeball. Conclusion Most of the endophthalmitis associated with filtering bleb is delayed endophthalmitis. Streptococcus and Staphylococcus are the most common pathogens. Although the infection is successfully treated, but the visual acuity is poor.