玻璃体切割术治疗眼内炎的临床分析

Clinical analysis of vitrectomy for endophthalmitis

的 探讨眼内炎的病因构成及玻璃体切割术治疗眼内炎的临床效果。 方法 对我院1999年 1月～ 2 0 0 1年 12月收治的眼内炎患者 5 3例 5 4只眼进行回顾性分析 ,男 38例 ,女 15例 ,年龄 1～74岁 ,平均年龄 32岁。对 2例 ( 2只眼 )炎症较轻的患者仅采用药物治疗 ,5例 ( 5只眼 )视力无光感 ,炎症反应重的患者行眼球内容物剜除术 ,其余 46例 ( 47只眼 )均采用常规三通道玻璃体切割术。随访 2～ 32个月 ,平均 10 .5个月。结果 眼球穿通伤导致的眼内炎共 32只眼 ,占 5 9.2 6 %。内源性眼内炎 8只眼 ,占14.81%。与白内障手术相关的眼内炎共 7只眼 ,占 12 .96 % ,青光眼手术晚期滤泡感染 2只眼 ,占 3.70 %。玻璃体切割术后 3只眼 ,占 5 .5 6 %。放射状角膜切开术 ( radial keratotomy,RK)后 1只眼 ,占 1.85 %。原因不明 1只眼 ,占 1.85 %。经治疗后患者视力明显提高 ( P=0 .0 0 3)。 3d内行玻璃体切割术患者的视力恢复明显高于 3d后的患者 ( P=0 .0 14) ,7d内行玻璃体切割术患者的视力恢复明显优于 7d后的患者 ( P=0 .0 2 1)。功能成功 (视力≥ 0 .0 2 ) 37只眼 ,占 6 8.5 2 % ;解剖成功 (视力 <0 .0 2 ,眼球结构完整 ) 4 7只眼 ,占87.0 4% ,脱盲 (视力≥ 0 .0 5 ) 2 7只眼 ,占 5 0 .0 0 %。

ObjectiveTo investigate the etiological factors of endophthalmitis and evaluate the outcomes of vitrectomy for endophthalmitis.MethodsFrom January 1999 to December 2001, 53 consecutive patients (54 eyes ), 38 men and 15 women, diagnosed as endophthalmitis were retrospectively evaluated. The patients′ ages ranged from 1 year to 74 years (mean 32 years). Two patients (2 eyes) with mild inflammation received antibiotic medication therapy, 5 patients (5 eyes) with no light perception and severe inflammation underwent evisceration, and the other 46 patients (47 eyes) underwent pars plana vitrectomy. Postoperative follow-up ranged from 2 to 32 months (mean 10.5 months). ResultsEndophthalmitis was diagnosed as resulting from penetrating injury in 32 eyes (59.26%), endogenous endophthalmitis in 8 eyes (14.81%), cataract surgery in 7 eyes (12.96%), glaucoma surgery in 2 eyes (3.70%), vitrectomy in 3 eyes (5.56%), radial keratotomy in 1 eye (1.85%), and unknown reason in 1 eye (1.85%). The postoperative visual acuities (VA) of these patients increased significantly (P=0.003). The VA of the patients underwent vitrectomy in 3 days was obviously better than those after 3 days (P=0.014), and the VA of the patients underwent vitrectomy in 7 days was obviously beter than those after 7 days (P=0.021). Thirty-seven eyes (68.52%) had functional success (VA≥0.02), 47 eyes (87.04%) had anatomical success (VA<0.02), and 27 eyes (50.00%) were out of blindness (VA≥0.05).ConclusionsPenetrating ocular injury, especially with retained intraocular foreign bodies, is the most common cause of suppurative endophthalmitis. Vitrectomy is a good method for the treatment of endophthalmitis.