白内障术后急性感染性眼内炎的临床特征

Clinical features of acute infectious endophthalmitis after cataract surgery

目的探讨天津医科大学眼科医院白内障手术后急性感染性眼内炎的临床特征。方法回顾性分析2007年12月至2017年12月在我院行白内障手术后发生急性感染性眼内炎患者的临床资料,共有28例(28眼)发生眼内炎。统计患者性别、年龄、发病率、白内障术后眼内炎的发病时间、病原体种类、治疗方式、出院时患者的视力及基础疾病的情况。结果我院近十年有28例28眼发生白内障术后急性感染性眼内炎,发病率为0. 041%,其中男10例10眼,发病率为0. 015%,女18例18眼,发病率为0. 026%;患者的年龄为25～84(66. 11±13. 80)岁;发生白内障术后急性感染性眼内炎的时间为(8. 39±6. 92) d;怀疑患有眼内炎并首次检查患者时,角膜水肿的发病率为64. 3%(18/28),前房积脓的发病率为42. 9%(12/28); 17眼在确诊后行玻璃体切割术联合玻璃体内注药,11眼只接受了前房和(或)玻璃体内注药;治疗后患者的视力为(0. 90±0. 86) log MAR;患者病原体培养的阳性率为64. 3%,其中表皮葡萄球菌10眼,约占35. 7%。结论白内障术后急性感染性眼内炎的发生受多种因素的影响;感染的致病菌以凝固酶阴性的表皮葡萄球菌为主;患者视力的恢复和初次检查时临床表现的严重程度相关;确诊后及时行玻璃体切割术可以提高患者的最终视力。

Objective To explore the clinical features of acute infective endophthalmitis after cataract surgery in Tianjin Medical University Eye Hospital.Methods The clinical data of patients with acute infectious endophthalmitis after cataract surgery in our hospital from December 2007 to December 2017 were retrospectively analyzed.A total of 28 patients( 28 eyes) developed endophthalmitis.The patient’s gender,age,morbidity,time of onset of endophthalmitis after cataract surgery,pathogen type,treatment methods,visual acuity of patients at discharge and underlying diseases were recorded.Results There were 28 patients( 28 eyes) with acute infectious endophthalmitis after cataract surgery in the last ten years,and the incedence rate was 0.041 %,including 10 eyes in 10 males with an incidence rate of 0.015 % and 18 female eyes,with an incidence rate of 0.026 %.The average age of patients was 25-84( 66.11 ± 13.80) years.The average time of acute infectious endophthalmitis after cataract surgery was( 8.39 ± 6.92) days.Patients suspected of having endophthalmitis underwent examination of the eyes for the first time,and reported the incidence of corneal edema of 64.3 %( 18/28),and hypopyon of 42.9 %( 12/28),and 17 eyes underwent vitrectomy combined with intravitreal injection in the vitreous body after final diagnosis,and 11 eyes received anterior chamber and/or intravitreal injection.After treatment,the mean visual acuity of the patients was( 0.90 ± 0.86) logMAR; the positive rate of bacterial culture in patients was 64.3 %,including Staphylococcus epidermidis in 10 eyes( 35.7 %).Conclusion The occurrence of acute infectious endophthalmitis after cataract surgery is influenced by many factors.The pathogen of infection is mainly coagulase-negative Staphylococcus epidermidis.The visual acuity of the patients is related to the severity of the clinical manifestations at the initial examination.Timely vitrectomy can improve the final vision of patients after diagnosis.