内源性眼内炎的临床特征分析

Analysis on clinical characteristics of endogenous endophthalmitis

目的分析内源性眼内炎患眼的临床特征,为临床早期诊断及治疗提供依据。方法收集内源性眼内炎患者11例(12眼)的临床资料,对其临床特点、易感因素、病原学培养结果、手术方法及预后进行分析研究。结果本研究纳入患者11例(12眼),包括单眼10例,双眼1例。主要的眼部体征为结膜充血、角膜水肿及角膜后KP、前房闪辉、前房积脓及玻璃体混浊,眼底均窥不清。首诊误诊为其他疾病的为6例(6眼),其中5例(5眼)为外院误诊后转入我院明确诊断及治疗,误诊率为50%;伴全身基础疾病10例(11眼),占91.7%,有明确感染灶6例(7眼),占58.3%。所有患眼均行眼内液细菌、真菌及厌氧菌培养和药物敏感试验,培养结果阳性者9例(10眼),占83.3%,其中肺炎克雷伯菌为4例(5眼),占41.7%。8例(9眼)(72.7%)患者通过玻璃体腔注药术或联合玻璃体切割手术病情得到控制,3例(3眼)(27.3%)患者因炎症未能控制行眼内容物剜出手术。末次随访时,视力较前提高的5只眼,占41.7%,视力无明显改变2只眼,占16.7%,较前下降2只眼,占16.7%,但视力均较差,在光感~0.15之间。结论内源性眼内炎早期表现缺乏特异性,初诊不易诊断,预后差;全身易感因素及原发灶是内源性眼内炎的主要致病因素;病原学检查均为细菌,其中主要为肺炎克雷伯菌;及时、有效的玻璃体腔注射抗生素及联合玻璃体切割手术能最大限度地挽回视功能。

Objective To analyze the clinical characteristics of eyes with endogenous endophthalmitis and to provide evidence for early clinical diagnosis and treatment.Methods The clinical data of 11 patients(12 eyes)diagnosed with endogenous endophthalmitis were collected,and their clinical characteristics,susceptibility factors,etiological culture results,surgical methods and prognosis were analyzed and studied.Results 11 patients(12 eyes)were included in this study.The main ocular signs were conjunctival hyperemia,corneal edema and retrocorneal KP,anterior chamber flare,hypopyon and vitreous opacity,and the fundus was unclear.6 cases(6 eyes)were misdiagnosed as other diseases at the first diagnosis,of which 5 cases(5 eyes)were misdiagnosed in other hospitals and then transferred to our hospital for definite diagnosis and treatment,with a misdiagnosis rate of 50%;10 cases(11 eyes)with systemic underlying diseases(91.7%),6 cases(7 eyes)with clear infection foci(58.3%).All eyes were subjected to intraocular fluid bacterial,fungal and anaerobic culture and drug sensitivity test.The culture results were positive in 9 cases(10 eyes,83.3%),of which 4 cases(5 eyes)were Klebsiella pneumoniae(41.7%).8 cases(9 eyes)(72.7%)were controlled by intravitreal injection or combined vitrectomy,and 3 cases(3 eyes)(27.3%)underwent enucleation of ocular contents due to uncontrolled inflammation.At the last follow-up,5 eyes had improved visual acuity,accounting for 41.7%,2 eyes had no obvious change in visual acuity,accounting for 16.7%,and 2 eyes had decreased compared with the previous(16.7%),but the visual acuity was poor.Conclusion The diagnosis is difficult at first time because early manifestation lack specificity in endogenous endophthalmitis;systemic susceptibility factors and primary lesions are the main pathogenic factors of endogenous endophthalmitis;pathogenic examinations are all bacteria,and the main for Klebsiella pneumoniae;timely and effective intravitreal injection of antibiotics and combined vitrectomy can maximize the recovery of visual function.