10例内源性细菌性眼内炎患眼临床特征观察  

Clinical features of 10 cases with endogenous bacterial endophthalmitis

作　　者：毛春洁[1] 田强[1] 由彩云[1] 周伟[1] 江枫[1] 颜华[1] 

机构地区：[1]天津医科大学总医院,300052

出　　处：《中华眼底病杂志》2017年第2期162-165,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：天津市卫生局科技基金（2013KZ119）

摘　　要：目的 观察内源性细菌性眼内炎患眼的临床特征.方法 回顾性病例研究.临床检查确诊的内源性细菌性眼内炎患者10例10只眼纳入研究.其中,男性7例7只眼,女性3例3只眼;均为单眼.平均年龄（57.6±10.8）岁.伴全身疾病9例.其中,糖尿病8例,病程超过5年7例;肝硬化、高血压、冠心病分别为3、1、1.有明确感染性疾病9例.其中,肝脓肿7例,伴肺部感染3例;丹毒、肛周脓肿各1例.既往有发热病史7例.玻璃体切割手术或眼内容物剜除手术时抽取玻璃体液行需氧菌、厌氧菌、真菌培养和药物敏感试验9只眼.其中,玻璃体切割手术8只眼;眼内容物剜除手术1只眼.所有患者全身使用广谱抗生素治疗,并根据微生物培养及药敏感试验结果调整用药.明确诊断后,5、24 h内行玻璃体切割手术联合晶状体切除3、5只眼;玻璃体腔填充C3F8、硅油1、7只眼.手术结束时玻璃体腔均注射10 mg/ml的万古霉素0.1 ml（含万古霉素1 mg）和10 mg/ml的头孢他啶0.1 ml（头孢他啶1 mg）.单纯玻璃体腔注药1只眼,药物、剂量相同;单纯全身药物治疗1只眼.随访6～24个月,观察患眼视力变化及病原菌培养结果.结果 患者均主诉视物模糊,其中伴眼部疼痛5例.患眼视力无光感3只眼;光感5只眼;手动1只眼;0.1者1只眼.角膜水肿10只眼;前房积脓8只眼;玻璃体弥漫性混浊10只眼,其中伴视网膜脱离3只眼.行玻璃体切割手术和玻璃体腔注药的8只眼中,因炎症未能控制行眼内容物剜出手术1只眼.单纯玻璃体注药的1只眼,炎症未能控制,眼球萎缩行眼球摘除手术.行玻璃体液培养的9只眼中,培养结果阳性者8只眼,占88.9％.其中,肺炎克雷白杆菌5只眼;金黄色葡萄球菌、无乳链球菌、粪肠球菌各1只眼.末次随访时,视力无光感2只眼;手动4只眼;0.1者1只眼.结论 全身易感因素是内源性细菌性眼内炎主要致病因素;肺炎克雷白杆菌是导致眼内感染的主要病原Objective To observe the clinical features and prognosis of endogenous bacterial endophthalmitis （EBE）.Methods Ten eyes of 10 patients diagnosed with unilateral EBE were retrospectively reviewed,including 7 males and 3 females.The mean age was 57.6± 10.8 years old.Eight patients were with diabetes and 7 of them were diagnosed over 5 years.There were 3 patients with hepatocirrhosis,1 patient with hypertension,and 1 patient with coronary disease.Nine cases had infectious diseases,including liver abscess （7 cases）,pulmonary infection （3 cases）,erysipelas （1 case） and perianal abscess （1 case）.Seven cases had fever history.Culture and drug sensitive tests for aerobic bacteria,anaerobic bacteria and fungal were performed for 9 eyes using vitreous samples from the procedures of vitrectomy and/or intravitreal injection.All patients were treated with broad-spectrum antibiotics and adjusted for drug use according to microbiological culture and drug sensitivity test results.After the diagnosis was established,vitrectomy combined with lens removal was performed in 5 hours （3 eyes） and 24 hours （5 eyes）;Vitreous tamponade of C3F8 （1 eye） and silicone oil （7 eyes） was used;At the end of the operation,0.1 ml vancomycin （1 mg） and 0.1 ml ceftazidime （1 mg） were injected into the vitreous cavity.One eye received intravitreal injection of 0.1 ml vancomycin （1 mg） and 0.1 ml ceftazidime （mg）,one eye received evisceration.During the follow up period from 6 to 24 months,visual function,slit lamp and fundus examinations were performed at each office visit.Results All patients complained of blurred vision and 5 patients had ocular pain.The visual acuity was no light perception （3 eyes）,light perception （5 eyes）;hand motion （1 eye） and 0.1 （1 eye）.Corneal edema was found in all 10 eyes;hypopyon in 8 eyes;diffuse vitreous opacity in 10 eyes,including 3 eyes with retinal detachment.For 8 eyes treated by vitrectomy and intravitreal injection,1 eye was eviscerated due to

关 键 词：眼内炎/诊断 眼内炎/治疗 眼内炎/病因学 

分 类 号：R771[医药卫生—眼科]