白内障摘除联合人工晶状体植入术后急性感染性眼内炎的临床观察  

Clinical observation of acute infective endophthalmitis after cataract extraction combined with intraocular lens implantation

作　　者：陈倩茵[1] 张静琳[1] 林振德[2] 武哲明 林慧敏 Chen Qianyin;Zhang Jinglin;Lin Zhende;Wu Zheming;Lin Hulmin(Department of Fundus Disease;Department of Cataract, Guangzhou Aier Eye Hospital, Guangzhou 510060, China)

机构地区：[1]广州爱尔眼科医院眼底病科,510060 [2]广州爱尔眼科医院白内障科,510060

出　　处：《中华眼科医学杂志（电子版）》2018年第1期9-14,共6页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

基　　金：广东省医学科学技术研究基金(C2017028);广州市卫生局医学卫生科技项目(20171A011332)

摘　　要：目的探讨白内障摘除联合人工晶状体(IOL)植入术后急性感染性眼内炎的治疗策略。方法收集2011至2017年广州爱尔眼科医院收治并诊断为白内障摘除联合IOL植入术后发生急性感染性眼内炎的9例患者的临床资料。其中,在广州爱尔眼科医院进行白内障手术后发生眼内炎的患者1例,在基层医院行白内障手术后发生眼内炎的转诊患者8例。查阅患者的视力、眼压、眼前节、眼部B超扫描等检查结果。对患者行玻璃体切除术(PPV),并依据患者的感染情况行IOL取出+硅油填充术。手术中常规取前房液和玻璃体液进行细菌和真菌培养。结果在9例患者中,糖尿病患者1例,高血压患者2例,其余无长期全身疾病。本文中所有患者发生急性感染性眼内炎的时间均在白内障手术后1~9 d,表现为术眼剧痛、视力急剧下降、结膜充血水肿、角膜不同程度水肿、房水混浊伴或不伴前房积脓及出现前房渗出膜等症状。眼部B超检查结果显示患者的玻璃体混浊,眼底窥不见。在9例急性感染性眼内炎患者中,有8例患者及时进行PPV治疗,1例患者由于角膜混浊未能进行完整的PPV;7例患者术前曾行前房冲洗及取材行病理涂片,6例患者于PPV前进行玻璃体腔内注射万古霉素;术后早期有3例患者取出IOL联合硅油填充术,其余6例患者保留IOL以及眼内注药,无填充硅油。9例患者中有7例患者术后视力较术前有所提高,其中最佳矫正视力在0.01~0.09的有2例,在0.1~0.3的有3例,在0.3~0.5的有2例,1例患者术后视力无提高,1例患者由于感染不能控制,进行眼内容物剜除术。结论 PPV是白内障摘除术后急性感染性眼内炎有效控制感染的治疗方法。对于角膜条件相对较好的眼内炎患者积极行PPV是保留患者视功能的关键。Objective To observe and discuss the treatment strategy of acute infective endophthalmitis after cataract extraction combined with intraocular lens（ IOL） implantation.Methods The clinical data of 9 patients with acute infectious endophthalmitis after cataract extraction and IOL implantation were collected from 2011 ～ 2017 years＇ ophthalmology hospital in Guangzhou.Among them,there was one case of endophthalmitis after cataract surgery in Guangzhou Eye Hospital,8 cases of endophthalmitis referral patients after cataract surgery in primary hospitals.Check the results of the patient＇s visual acuity,intraocular pressure,anterior segment,ocular ultrasound scan and so on.The patients were treated with parsplana vitrectomy（ PPV） and the patients were infected with IOL and silicone oil filling.During the operation,the anterior chamber fluid and the glass fluid were given to the bacteria and fungi.Results Among the9 patients,there were 1 patients with diabetes,2 patients with hypertension,and the rest had no long-term systemic disease.All patients in this acute infectious endophthalmitis after cataract surgery in time was 1 ～9 days,showed a sharp decline in visual acuity,eye pain,conjunctival hyperemia and edema,corneal edema of different degrees,aqueous humor with/without hypopyon and anterior chamber exudation membrane etc..The results of ocular ultrasound examination revealed the vitreous opacity of the patient and the fundus of the eyes were not seen.In 9 cases,8 cases were treated by full vitrectomy and one case of full vitrectomy was not performed due to corneal opacity.6 cases were practiced intravitreal injection before vitrectomy.In the first 3 cases were taken out with IOL and silicone tamponade,but the other 6 cases were not necessary of IOL removal and silicone tamponade.Postoperative visual acuity was improved in 7 of 9 cases.Visual acuity0.01 ～ 0.09 were in 2 cases,0.1 ～ 0.3 were in 3 cases and 0.3 ～ 0.5 were in 2 cases.one case with no improvement of vision and 1 case was practiced evi

关 键 词：急性感染性眼内炎 白内障摘除术 玻璃体切除术 

分 类 号：R779.6[医药卫生—眼科]