细菌性眼内炎的玻璃体手术与病原学诊断  

Vitreal surgery and etiological diagnosis of bacterial endophthalmitis

作　　者：叶俊杰[1] 郭立斌[2] 王淑然[1] 王伟伟[1] 闵寒毅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730 [2]北京崇文光明医院北京军区空军司令部门诊部眼科

出　　处：《中华眼科杂志》2012年第11期995-1000,共6页Chinese Journal of Ophthalmology

摘　　要：目的探讨细菌性眼内炎的玻璃体手术疗效与病原学诊断的重要性。方法回顾性系列病例研究。收集20例（20只眼）经临床诊断的细菌性眼内炎患者临床资料，进行回顾性分析。20例患者中，男性12例，女性8例；年龄3～83岁，平均（40．5±23．9）岁；14只眼为外伤性眼内炎，6只眼为内眼手术后感染性眼内炎。初诊视力：眼前指数2只眼；眼前手动6只眼；眼前光感11只眼，光定位均不确定；无光感1只眼。13只眼前房积脓，7只眼前房炎性反应较重。20只眼的眼底红光反射均消失，眼底不能窥人。B超显示20只眼玻璃体均呈中至重度混浊，12只眼玻璃体、视网膜表面有机化条索，2只眼视网膜脱离。对18只眼行玻璃体切除联合抗生素注入术，其中9只眼行硅油填充术；2只眼单纯行抗生素玻璃体注药术。20只眼均于手术开始即取玻璃体液进行涂片和革兰染色。根据革兰染色结果即刻选择抗生素，阳性者选用万古霉素1mg，玻璃体注射或加入灌注液中；阴性者使用头孢他啶2mg玻璃体注射，或4mg加入灌注液中。同时行细菌培养和药物敏感试验，根据检测结果继续或调整眼部及全身用药。患者随诊1—102个月，平均16．6个月。结果玻璃体脓液涂片革兰染色阳性13只眼（65％），革兰染色阴性3只眼（15％），另有4只眼（20％）未发现细菌。15只眼细菌培养结果阳性，病原体检出率75％，其中金黄色葡萄球菌、表皮葡萄球菌各3只眼，芽孢杆菌2只眼，肺炎链球菌、草绿色链球菌、英志贺邻单胞菌、洋葱假单胞菌、产酸克雷伯菌、洛菲不动杆菌及荧光假单胞菌各1只眼。另外5只眼细菌培养显示无菌生长。术后20只眼感染均得到控制，眼内炎症消退。视力均有提高，视力≥0．3者4只眼，0．1—0．2者4只眼，0．02～0．09者6只眼，眼前指数2只眼，眼前手动3只眼，眼前光感1�Objective To evaluate the clinical effects of vitreal surgery and the importance of etiological diagnosis in the treatment for bacterial endophthalmitis. Methods Retrospective series case study. 20 cases （20 eyes ） of bacterial endophthalmitis that were treated in Peking Union Hospital were enrolled. 14 eyes were post-traumatic endophthalmitis, and 6 eyes were postoperative endophthalmitis. Twenty cases of aged 3 to 83 years [ mean（40.5 ＋_ 23.9）years] were enrolled, including 12 male and 8 female patients. Pre-operative visual acuity ： 2 cases were able to count fingers, 6 cases were able to perform hand movement, 11 cases had light perception, light projection were uncertain in all cases, and there was no light perception in 1 case. Hypopyon was seen in 13 eyes. Severe anterior chamber inflammatory reaction was seen in the other 7 eyes. The fundus could not be observed in all 20 eyes. B-Scan ultrasound examination indicated that all 20 eyes displayed moderate to severe vitreous opacity; proliferation and organization were apparent in 12 eyes, and retinal detachment in 2 eyes. Vitreetomy and intravitreal injection of antibiotics were performed in 18 eyes, and only intravitreal injection of antibiotics was administered in the other 2 eyes. At the beginning of operation, vitreous fluids were smeared and Gram stained. To eyes that showed a positive result in Gram staining, 1 mg of Vancomycin was injected into the vitreous cavity or added in the perfusion fluid （balanced salt solution, BSS） in the eyes. To eyes that showed a negative result in Gram staining, 2 mg or 4 mg of Ceftazidime was injected into the vitreous cavity or added in the perfusion fluid （BSS） in the eyes, respectively. Additionally, we examined the vitreous specimens and performed drug susceptibility testing of the bacteria cultured from the specimens. The antibiotics that the bacteria were susceptible to were chosen according to the drug sensitivity tests. The follow-up period is from 1 to 102 months （ average 16.6 months）.

关 键 词：眼感染 细菌性 眼内炎 玻璃体切除术 玻璃体内注射 细菌学技术 

分 类 号：R779.6[医药卫生—眼科]