内源性眼内炎7年临床回顾性分析

A 7-year clinical retrospective analysis of endogenous endophthalmitis

目的分析研究内源性眼内炎的临床特点、治疗方法及预后。方法确诊为内源性眼内炎并住院治疗的17例(17眼)患者,术前均进行常规眼科检查,眼表分泌物一般细菌涂片检查、细菌培养+药敏,对所有患眼均取玻璃体或者房水进行细菌、真菌培养+药敏,根据情况完善血常规+C反应蛋白、尿常规、肾功能、肝功能、离子、血培养+药敏,胸部CT,肝胆脾彩超等全身相关检查。结果17例患者治疗前最佳矫正视力为光感~手动/30 cm,眼压8~19 mm Hg(1 mm Hg=0.133 kPa)。其中6例为呼吸道感染后出现视力下降、眼红、眼痛等眼部症状,其他12例均无明显诱因;8例患者是以葡萄膜炎为初次诊断收入院,经详细检查后诊断为内源性眼内炎。经过治疗后17眼有5眼视力提高,其中4眼由光感恢复至0.02~0.08,1眼视力由手动/30 cm恢复至0.1;10眼维持光感或手动/眼前的视力;2眼仍无光感,其中1眼随访至3个月出现眼球萎缩后行眼球摘除术,一期未植入义眼台。结论内源性眼内炎是一种发病率低的严重致盲性眼病,早期诊断并及时给予局部、全身抗生素治疗,玻璃体腔注药术、经睫状体平坦部玻璃体切割术等积极有效的手术治疗可以保留光感甚至提高视力。

Objective To analyze the clinical characteristics,treatment method and prognosis of endogenous endophthalmitis.Methods A total of 17 patients(17 eyes)who were diagnosed with endogenous endophthalmitis and hospitalized were selected.All patients underwent routine ophthalmic examinations before surgery,including general bacterial smear examination of ocular surface secretions,bacteria culture+drug susceptibility.Vitreous or aqueous humor was collected from all eyes for bacterial and fungal culture+drug susceptibility,and blood routine+C-reactive protein,urine routine,renal function,liver function,ion,blood culture+drug susceptibility,chest CT,liver,gallbladder and spleen color Doppler ultrasound and other systemic related examinations.Results The best corrected visual acuity of 17 patients before treatment was light perception-manual/30 cm,and intraocular pressure was 8-19 mm Hg(1 mm Hg=0.133 kPa).Among them,6 cases had eye symptoms such as vision loss,eye redness,and eye pain after respiratory infection,and the other 12 cases had no obvious incentives;8 patients were admitted to hospital with uveitis as the initial diagnosis,and were diagnosed as endogenous endophthalmitis after detailed examination.After treatment,the visual acuity of 5 eyes of 17 affected eyes improved,of which 4 eyes recovered from light perception to 0.02-0.08,and 1 eye recovered from manual/30 cm to 0.1;10 eyes maintained light perception or manual/anterior vision.vision;2 eyes still had no light perception,of which 1 eye was followed up to 3 months.After eyeball atrophy,enucleation was performed,and no artificial eye platform was implanted in the first stage.Conclusion Endogenous endophthalmitis is a kind of serious blindness eye disease with low incidence.Early diagnosis and timely local and systemic antibiotic treatment,vitreous cavity injection,tranciliary body flat vitrectomy and other active and effective surgical treatment can preserve light perception and even improve vision.