玻璃体切割手术治疗化脓性眼内炎

Pars plana vitrectomy in the treatment of endophthalmitis

目的 观察玻璃体切割手术治疗化脓性眼内炎的疗效。方法 对 1999年 6月～ 2 0 0 3年 2月在我院行玻璃体切割术的 14例 (14只眼 )化脓性眼内炎患者进行回顾性分析。除眼内异物外 ,其余患者临床诊断化脓性眼内炎后均先采用保守治疗 ,密切观察 1～ 2天无好转而行玻璃体切割手术。眼内炎的原因 :眼球穿通伤 13只眼 ,青光眼术后晚期滤过泡感染 1只眼。玻璃体切割手术前先抽取前房及玻璃体腔内液体涂片及培养。采用标准三通道闭合式玻璃体切割手术 ,7只眼因前房积脓及晶状体前大量渗出和 3只眼外伤性白内障影响手术而同时切除晶状体 ,8只联合巩膜环扎。缝合巩膜切口后玻璃体腔内注射罗氏芬 2 .5 mg及地塞米松 0 .4mg。术后全身继续使用抗生素及激素 1周。术后平均随访 14.8个月 (2～ 2 4个月 )。结果 14只眼中术后视力提高 12只眼 (85 .7%) ,眼球保留13只眼 (92 .6 %)。 5只眼培养阳性。术后玻璃体腔内少量出血 2只眼 ,无其它手术并发症。结论 玻璃体切割手术联合眼内注射抗生素治疗化脓性眼内炎疗效可靠。只要手术时机选择适当 ,大多数患者能保住眼球 。

Objective The aim of the study was to assess the results obtained after performing vitrectomy in patients with endophthalmitis.Methods From June 1999 to February 2003,14 patients with endophthalmitis were retrospectively evaluated.Endophthalmitis was diagnosed as resulting from penetrating injury in 13 eyes,fistula operations in 1 eyes.In all patients prior to surgical procedure samples of the vitreous were collected for bacteriology and mycology tests.All eyes underwent pars plana vitrectomy and intraocular and systermic antibiotic treatment.the average follow-up period was 14.8mons (2mons～24mons).Results The postoperative visual acuities increased in 12 eyes (85.7%).Anatomization succeeds in 13 eyes (92.6%).Positive cultures were obtained in 5 patients.2 patients suffered little vitreal hemorrhage postoperatively.No other complications occurred.Conculsion Vitrectomy in combination with intraocular antibiotics is an effective method for the treatment of endophthalmitis.In patients with endophthalmitis early performed vitrectomy may lead to good functional outcome.