感染性眼内炎的致病因素及临床特点分析

Analysis on the pathogenic factors and clinical characteristics of infectious endophthalmitis

目的分析感染性眼内炎的致病因素及临床特点。方法横断面研究。收集2017年1月1日至2022年2月20日就诊于海南医学院第一附属医院的感染性眼内炎46例(46只眼)的临床资料,分析其一般资料、致病原因、病原菌分布情况、治疗方法及效果。结果其中男性28例,女性18例,年龄21~89(59.26±15.53)岁。其中外伤性及手术源性感染性眼内炎为主要病因,外伤性眼内炎以铁屑、铁片等铁器类外伤为主,手术源性感染性眼内炎以白内障手术为主,内源性眼内炎以不明原因为主,感染性角膜炎所致眼内炎以角膜溃疡为主。感染性眼内炎患者中,入院前视力>0.02者占2.17%(1/46),出院时占23.91%(11/46),差异具有统计学意义(χ^(2)=10.65,P=0.005)。外伤性眼内炎患者治疗后视力>0.02占比较治疗前提高,差异具有统计学意义(χ^(2)=6.94,P=0.035)。46例病原菌培养阳性率为30.43%(14/46),以凝固酶阴性葡萄球菌及铜绿假单胞菌为主,其中20例采用玻璃体切除术联合玻璃体腔注药治疗。结论感染性眼内炎的致病原因以外伤性及手术源性为主,玻璃体切除术联合玻璃体腔注药为主要的治疗手段。

Objective To analyze the pathogenic factors and clinical characteristics of infectious endophthalmitis.Methods This was a cross-sectional study.The clinical data of 46 eyes of 46 patients with infective endophthalmitis from Jan.2017 to Feb.2022 in the First Affiliated Hospital of Hainan Medical University were collected.The basic data,cause of disease,distribution of pathogens,treatment methods and efficacy were analyzed.Results There were 28 males and 18 females,aged from 21 to 89(59.26±15.53)years.Among them,traumatic and surgical endophthalmitis was the main cause.The main cause of traumatic endophthalmitis was the injury of iron scraps,iron sheets other iron objects,the main cause of surgical endophthalmitis was cataract surgery,the main cause of endogenous endophthalmitis was unknown,and the main cause of endophthalmitis caused by infectious keratitis was corneal ulcer.The infective endophthalmitis patients with visual acuity>0.02 occupied 2.17%(1/46)before admission,and the rate increased to 23.91%(11/46)after discharge(χ^(2)=10.65,P=0.005).The rate of visual acuity>0.02 of patients with traumatic endophthalmitis after treatment was higher than that before treatment(χ^(2)=6.94,P=0.035).Positive rate of pathogenic bacteria culture in 46 cases was 30.43%(14/46),mainly with coagulase negative staphylococcus aureus and pseudomonas aeruginosa.Among them,20 cases were treated with vitrectomy and intravitreal injection of drugs.Conclusion Infectious endophthalmitis is mainly caused by trauma and surgery.Vitrectomy in combination with intravitreal injection of drugs is the main method of treatment.