内源性眼内炎的临床分析  

Clinical analysis of endogenous endophthalmitis

作　　者：刘刚[1] 孙勇[1] 

机构地区：[1]新疆维吾尔自治区人民医院眼科,乌鲁木齐830001

出　　处：《中国中医眼科杂志》2014年第4期272-274,共3页China Journal of Chinese Ophthalmology

摘　　要：目的 探讨内源性眼内炎的临床特征和治疗方法.方法 回顾性病例分析.2010年至2013年收治的内源性眼内炎患者8例（10只眼）,男3例（5只眼）,女5例（5只眼）,年龄34～68岁;双眼2例,右眼4例,左眼2例.予常规眼科检查,玻璃体标本涂片培养,血培养.治疗包括局部及全身抗菌药物治疗,行玻璃体注药或（和）玻璃体切割术.对所有患者的发病情况、微生物培养结果、治疗结局进行统计分析.结果 8例患者发病前均有高热病史.糖尿病4例,其中3例合并肝脓肿,亚急性细菌性心内膜炎1例,妇科手术史1例,肾功能衰竭透析合并感染1例,败血症1例,不明原因发热1例.微生物血培养阳性3例（50％,3/6）,玻璃体液培养阳性2只眼（40％,2/5）,病原微生物包括肺炎克雷伯菌、大肠埃希菌、溶血性链球菌、白色念珠菌.2例（4只眼）因全身情况差未行眼内注药和玻璃体切除,视力无光感,其余患眼治疗后视力光感～0.1,施行玻璃体切除手术患眼视力相对较好.结论 内源性眼内炎大部分患者存在全身易感因素,预后差.及时诊断、及时抗感染治疗是控制感染的最有效方法,必要时行玻璃体切割术联合抗生素治疗,有助于保存患者的部分视力.OBJECTIVE To investigate the clinical features and treatment of endogenous endophthalmitis. METHODS Participants were 8 cases （10 eyes ） with endogenous endophthalmifis in Xinjiang Renmin Hospital from 2010 to 2013.There were 3 males （5 eyes） and 5 females （Seyes） , aged from 34 to 68 years,2 cases in both eyes, 4 cases in the right eye and 2 cases in the left eye. All patients completed routine ophthalmic examination. Vitreous body was smeared, cultured and blood cultured. All cases received local and systemic antibiotic drug therapy, and were treated by intravitreal injection or/and vitrectomy. All patients on the incidence, microbiological culture results, treatment outcomes were analyzed. RESULTS Eight patients had high fever before illness, 4 cases of dia- betes including 3 with hepatic abscess, 1 of subacute bacterial endocarditis, 1 of gynecologic operation history, 1 of hemodialysis renal failure complicated with infection, 1 of septicemia, 1 of fever of unknown origin. Microbial blood culture was positive in 3 cases （50%, 3/6）, vitreous fluid culture was positive in 2 eyes （40% eyes, 2/5）, pathogenic microorganisms including Klebsiella pneumoniae, Eseherichia coli, Streptococcus hemolyticus, Candida albicans. Not giving intraocular drug injection and vitrectomy because of poor general condition, visual acuity of 2 cases （4 eyes） was no light perception. The rest of the eyes, the visual acuity of light perception to 0.1; the visual acuity of vitrectomy was relatively good. CONCLUSIONS As an ocular emergency, endogenous endophthalmitisis caused by bacteria and fungi from systemic focus of infection and sepsis was difficult to treat. Early diagnosis, proper systemic or topical anti-infective treatments were the most effective methods for controlling infection. Vitrectomy with intravenous antibiotics played an important role on preserving useful vision in patients.

关 键 词：内源性眼内炎 全身易感因素 治疗 

分 类 号：R771.2[医药卫生—眼科]