外伤性眼内炎的临床治疗分析  

Treatment evalution of posttraumatic endophthalmmitis

作　　者：王洪格 董晓光 田景毅 

机构地区：[1]山东省眼科医院,济南250021

出　　处：《中国实用眼科杂志》2008年第8期795-797,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的分析外伤性眼内炎的病原菌，探讨外伤性眼内炎的治疗中玻璃体切除的范围，以及视网膜脱离的复位时机。方法根据外伤性眼内炎的具体情况，在缝合穿通伤口和（或）异物取出的基础上，采取少部分玻璃体切除取标本和大部分玻璃体切除两种方式联合眼内注药治疗外伤性眼内炎。发生视网膜脱离者，待眼内炎症控制后，二期行玻璃体切除视网膜复位。结果47只眼中真菌感染7只眼，细菌感染40只眼；术后随访6～24月，平均随访9个月。治疗后炎症控制45只眼，其中矫正视力0．6～0．1者16只眼（34．04％），0．1～0．05者20只眼（42．55％），〈0．05光感者7只眼（14．89％），光感阴性2只眼（4．26％），眼压〈10mmHg者8只眼（17．02％）。2只眼（4．26％）炎症不能控制，行眼内容物剜除。5只眼（10．64％）在眼内炎治疗前合并视网膜脱离，炎症控制后有3只眼（6．38％）发生视网膜脱离，二期玻璃体手术均视网膜复位。结论细菌感染是外伤性眼内炎的主要原因，玻璃体切除联合玻腔注药治疗外伤性眼内炎彻底切除全部玻璃体并非必须，伴发视网膜脱离时可行二期手术复位。Objective To analysis the microbiology, evaluate the role of partial vitrectomy in posttraumatic ophthalmitis treatment, the retinal reattachment time for the detachment of ophthalmitis eyes. Methods After closure of penetration and/or removal of foreign body, intravitreal antibiotics and vitrectomy were performed. But some vitrectomy only for getting vitreous specimens and some for removal partial vitreous body. retinal detachment were reattached by vitrectomy after infection control .Results Of all 47 cases, Fungus infection for 7 eyes and bacteria infection for 40 eyes. Follow-up for 6-24 months and average for 9 months. 45 eyes infection are undercontrol, of these eyes, 16 eyes （34.04%）best corrected visual acuity （BCVA））0.1but 0.6,20 eyes（42.55%）BCVA-〉 0.05 but≥ 0.1,7 eyes（14.90%）〈0.05but ≥ light perception,2 eyes （4.25%）BCVA is light perception negative, 8 eyes （ 17.02% ）intraocular pressure lower thanl0mmHg.2 eyes （4.25%）of bacterial infection, inflammation involved in orbital tissue, performed evisceration.5 eyes accompanied by retinal detachment, reattached by vitrectomy after infection control.Conclusion The main microbiology for posttraumatic ophthalmitis is bacteria. Completely vitrectomy is not necessary. Accompanied retinal detachment can be reattached by secondary vitrectomy.

关 键 词：外伤性眼内炎 病原菌 玻璃体切除 二期玻璃体手术 视网膜复位 

分 类 号：R779.1[医药卫生—眼科] R563.1[医药卫生—临床医学]