肺炎克雷伯菌性眼内炎在糖尿病人群中的特点及预后分析  

Characteristics and prognosis of Klebsiella pneumoniae endophthalmitis in diabetic patients

作　　者：张小燕[1] 李姣[1] 李从心 原越 温莹[1] ZHANG Xiaoyan;LI Jiao;LI Congxin;YUAN Yue;WEN Ying(Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250002,China)

机构地区：[1]山东中医药大学附属眼科医院,济南250002

出　　处：《眼科学报》2023年第5期394-399,共6页Eye Science

基　　金：山东医药卫生科技发展计划项目(202007020875)~。

摘　　要：目的:分析肺炎克雷伯菌导致内源性眼内炎在糖尿病患者中的临床特征,总结治疗经验及评估其预后。方法:回顾性病例分析2019年1月至2022年3月期间就诊于山东中医药大学附属眼科医院的肺炎克雷伯菌导致的内源性眼内炎糖尿病患者7例(8眼)。分析其年龄、性别、感染灶来源、就诊时间、治疗前后视力、眼压、裂隙灯检查、眼底检查、眼科B超、治疗方式、感染控制及复发情况。结果:7例患者年龄(63±17.6)岁。男性5例(71.4%),女性2例(28.6%)。术后7眼(87.5%)视力NLP,1眼(12.5%)LogMAR视力0.2。视力与患者就诊时间及就诊时视力有关。6例(85.7%)就诊前发热。8眼(100%)结膜混合充血,1眼(12.5%)前房积脓。7眼(87.5%)行玻璃体切割术联合玻璃体腔注药术,1眼(12.5%)行单纯玻璃体腔注药术。8眼感染均控制,无眼球摘除。随访期间眼压正常,无感染复发。结论:肺炎克雷伯菌是内源性眼内炎的主要致病菌,易在糖尿病人群中发生。发病迅速进展快,早期临床表现不典型易被误诊,其预后和病程的长短及治疗的时机密切相关,尽早地治疗可挽回部分视力。Objective: To analyze the clinical characteristics of endogenous endophthalmitis caused by Klebsiella pneumoniae in diabetic patients, and summarize the treatment experience and evaluate its prognosis. Methods: A retrospective case analysis was performed on 7 patients (8 eyes) with endogenous endophthalmitis caused by Klebsiella pneumoniae, who were admitted to the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2019 to August 2022. The age, gender, origin of infection, time of treatment, visual acuity before and after treatment, intraocular pressure, slit lamp examination, fundus examination, ophthalmic B-mode ultrasound, treatment methods, infection control and recurrence were analyzed. Results: The mean age of the seven patients was (63±17.6). There were five males (71.4%) and 2 females (28.6%). Postoperative visual acuity was NLP in seven eyes (87.5%) and LogMAR visual acuity was 0.2 in one eye (12.5%). Visual acuity was related to the patient’s visit time and the visual acuity at visit. Six cases (85.7%) had fever before treatment. Fever was a risk factor for Klebsiella pneumoniae endophthalmitis infection. Eight eyes (100%) had mixed conjunctival congestion, and one eye (12.5%) had abscess in the anterior chamber. Seven eyes (87.5%) underwent vitrectomy combined with intravitreal drug injection, and one eye (12.5%) underwent intravitreal drug injection alone. Infections were controlled in all eight eyes without enucleation. Intraocular pressure was normal during the follow-up period, and there was no infection recurrence. Conclusions: Klebsiella pneumoniae is the main pathogen of endogenous endophthalmitis and is prone to occur in people with diabetes. The onset of the disease progresses rapidly. The early clinical manifestations are not typical, and the prognosis is closely related to the duration of the disease and the timing of treatment. Early treatment can restore some vision.

关 键 词：内源性眼内炎 肺炎克雷伯菌 玻璃体切除 眼内注药 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R771.3[医药卫生—内科学]