角膜缝线相关感染性眼内炎5例  

Five cases of corneal suture-associated infectious endophthalmitis

作　　者：宗媛 张婷 庄宏[1,2] 高凤娟 江睿 黄欣 Zong Yuan;Zhang Ting;Zhuang Hong;Gao Fengjuan;Jiang Rui;Huang Xin(Department of Ophthalmology,The Eye-ENT Hospital of Fudan University,Shanghai 200031,China;Ministry of Health Key Laboratory of Myopia,Shanghai Key Laboratory of Visual Damage and Reconstruction,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]卫生部近视眼重点实验室,上海市视觉损害与重建重点实验室,上海200031

出　　处：《中华眼底病杂志》2022年第5期366-370,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察角膜缝线相关感染性眼内炎患眼的临床特征及预后情况。方法回顾性病例分析。2020年1月至2021年12月于复旦大学附属眼耳鼻喉科医院眼科检查确诊的角膜缝线相关感染性眼内炎患者5例5只眼纳入研究。其中,男性3例,女性2例;均为单眼发病;年龄(30.80±21.98)岁。晶状体相关手术角膜切口缝线4只眼;穿透性角膜移植缝线1只眼。角膜缝线眼表存留时间(20.00±7.41)个月。5只眼中,因眼红、眼痛于外院给予角膜缝线拆除1只眼;其余4只眼中,缝线松动3只眼。给予患眼感染性眼内炎标准治疗,包括全身及局部抗感染治疗;角膜缝线拆除、眼内注药、玻璃体切割手术(PPV)治疗。PPV中根据情况决定是否给予硅油填充。治疗后随访时间(11.00±7.38)个月。观察分析手术前后患眼最佳矫正视力(BCVA)、B型超声及微生物培养结果等资料。结果患眼角膜可见围绕缝线的浸润、溃疡灶或脓肿。B型超声检查可见患眼全段玻璃体混浊、视网膜前机化条索、球壁水肿。玻璃体液培养结果阳性3只眼,分别为草绿色链球菌、人葡萄球菌人亚种、表皮葡萄球菌。治疗后所有患眼眼内感染均成功控制,无眼内容物剜除或眼球摘除者。治疗前,患眼BCVA为无光感~数指;治疗后,BCVA>0.3者2只眼。结论角膜缝线相关感染性眼内炎患眼角膜均可见围绕缝线的浸润、溃疡灶或脓肿,其与缝线长期存留于眼部有关;大部分患眼就诊时存在缝线松脱;及时治疗可有效控制感染,部分患眼视力预后良好。Objective To observe the clinical features and prognosis of eyes with corneal suture-related infective endophthalmitis.Methods A retrospective interventional case series.From January 2020 to December 2021,5 patients(5 eyes)with corneal suture-related infectious endophthalmitis diagnosed by ophthalmic examination at Department of Ophthalmology of the Eye-ENT Hospital of Fudan University were included in the study.Among them,there were 3 males and 2 females;all had unilateral disease;the mean age was 30.80±21.98 years.Sutures of 4 cases were secondary to lens related surgery and of 1 case was secondary to penetrating keratoplasty.Average retention time of corneal suture was 20.00±7.41 months.Of the 5 eyes,corneal sutures were removed in 1 eye due to redness and eye pain in another hospital;3 eyes were loosened of the sutures in the remaining 4 eyes.The patients were given standard treatment for infectious endophthalmitis,including systemic and local anti-infective therapy;corneal suture removal,intraocular injection,and vitrectomy(PPV).In PPV,it was decided whether to give silicone oil filling according to the situation.The follow-up time after treatment was 11.00±7.38 months.The best corrected visual acuity(BCVA),B-mode ultrasound and microbial culture results of the affected eye before and after surgery were observed and analyzed.Results Infiltrates,ulcers,or abscesses surrounding the suture may be seen on the cornea of the affected eye.B-mode ultrasonography showed vitreous opacity,preretinal cords,and spherical wall edema in the entire segment of the affected eye.The results of vitreous humor culture were positive in 3 eyes,which were Streptococcus viridis,Staphylococcus hominis subspecies,Staphylococcus epidermidis.After treatment,all the intraocular infections in the affected eyes were successfully controlled,and there were no cases of enucleation of ocular contents or enucleation.Before treatment,the BCVA of the affected eye was from no light perception to counting fingers;after treatment,2 eyes had BCVA>

关 键 词：眼内炎 角膜溃疡 缝线 抗感染药 玻璃体切除术 

分 类 号：R779.6[医药卫生—眼科]