肝脓肿引起的内源性眼内炎的临床观察  

Clinical observation of endogenous endophthalmitis caused by hepatapostema

作　　者：张小霞 王春芳[1] 苏强[1] 李春晖[1] Zhang Xiaoxia;Wang Chunfang;Su Qiang;Li Chunhui(Department of Ophthalmology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院眼科,太原030001

出　　处：《中华眼外伤职业眼病杂志》2024年第6期468-472,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析肝脓肿引起的内源性眼内炎的特点及治疗效果。方法回顾性病例系列研究。分析山西医科大学第一医院2018年9月至2023年9月就诊的肝脓肿引起内源性眼内炎12例(13眼)的临床资料,比较其手术前后的最佳矫正视力(BCVA,logMAR)、眼压、眼前节及眼底情况。结果所有患者通过腹部彩超、CT、MRI等检查明确诊断肝脓肿。患者中男性9例(10眼),女性3例(3眼);右眼9眼,左眼4眼;9例全身伴有糖尿病。血液培养结果呈阳性者4例,检出率为33.33%(4/12),3例为肺炎克雷伯杆菌感染。玻璃体液培养结果呈阳性者7例,检出率为58.33%(7/12),6例为肺炎克雷伯杆菌感染。患者出现眼部症状后未经治疗,至眼科后立即进行玻璃体切除联合晶状体摘出及硅油填充术。术前BCVA为2.48±0.99,术后视力提高至1.94±0.97(t=-3.82,P=0.003)。术前眼压(17.50±4.33)mmHg(1 mmHg=0.133 kPa),术后眼压(16.33±5.12)mmHg,差异无统计学意义(t=0.36,P=0.491)。术前患者呈不同程度角膜混浊、前房积脓;术后前房积脓消失,虹膜可见根切口。术前1例患者玻璃体轻微混浊,可见鼻上方视网膜前黄白色脓苔附着,余12例眼底窥不清;术后12例视网膜在位,1例行眼内容摘除术。结论肝脓肿引起内源性眼内炎的致病菌以肺炎克雷伯杆菌为主,玻璃体液培养结果阳性率较高,手术后视力改善。ObjectiveTo analyze the characteristics and the therapeutic effect of endogenous endophthalmitis caused by hepatapostema.MethodsThis was a retrospective case series study.The clinical data of 13 eyes of 12 patients with endogenous endophthalmitis caused by hepatapostema from Sep.2018 to Sep.2023 in the First Hospital of Shanxi Medical University were analyzed.Best corrected visual acuity(BCVA,logMAR),intraocular pressure,anterior segment and fundus before and after surgery were compared.ResultsHepatapostema was diagnosed by abdominal color ultrasound,CT and MRI.There were 9 males(10 eyes)and 3 females(3 eyes),included 9 eyes in the right eye and 4 eyes in the left eye.Nine cases had diabetes.Blood cultrue results were positive in 4 cases,the detection rate was 33.33%(4/12).Three patients were infected with Klebsiella pneumonia.Vitreous fluid culture results in 7 cases were positive,the detection rate was 58.33%(7/12).Six patients were infected with Klebsiella pneumonia.No treatment was given after the patients developed eye symptoms.Vitrectomy,lens removal and silicone oil tamponade were performed immediately after the patients were admitted to the ophthalmology department.Postoperative BCVA(1.94±0.97)was higher than the(2.48±0.99)before surgery(t=-3.82,P=0.003).Intraocular pressure before surgery was(17.50±4.33)mmHg(1 mmHg=0.133 kPa)and(16.33±5.12)mmHg after surgery,and the difference was statistically significant(t=0.36,P=0.491).The patients had different degrees of corneal edema and hypopyon before surgery.Hypopyon disappeared after surgery and the root incision was visible in the iris.Before operation,the vitreous turbidity was slight in 1 patient with yellow-white pus moss attached to the supranasal retina and the fundus was unclear in 12 patients.After operation,retina of 12 patients was in place,and 1 patient underwent eye evisceration.ConclusionKlebsiella pneumoniae is the main pathogen of endogenous endophthalmitis caused by hepatapostema.The positive rate of vitreous cavity fluid culture is higher a

关 键 词：眼内炎 内源性 肝脓肿 玻璃体切除术 克雷伯菌 肺炎 

分 类 号：R575.4[医药卫生—消化系统] R771.3[医药卫生—内科学]