首诊眼科的内源性肺炎克雷伯菌性眼内炎临床分析  

Clinical analysis of endogenous Klebsiella pneumoniae endophthalmitis on first-visit to the department of ophthalmology

作　　者：陈磊 陈放 华欣 朱俊 李姗姗 Chen Lei;Chen Fang;Hua Xin;Zhu Jun;Li Shanshan(Department of Ophthalmology,Northem Jiangsu People’s Hospital Affiliated to Yangzhou University,Northern Jiangsu People’s Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院眼科、江苏省苏北人民医院,扬州225001

出　　处：《中华眼外伤职业眼病杂志》2024年第8期615-619,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析首诊眼科的内源性肺炎克雷伯菌性眼内炎(EKPE)患者的临床特征及疗效。方法回顾性病例系列研究。收集江苏省苏北人民医院2010年9月至2022年3月以眼部表现首诊于眼科的8例(8眼)EKPE患者的临床资料。8例患者根据眼部病情行玻璃体内注药术、玻璃体切除术或眼内容摘除术。其中4例2019年后接受多学科联合诊疗模式,分析比较患者的诊疗效果。治疗后随访1个月至2年。结果8例患者原发灶均为肝脓肿。初诊时最佳矫正视力:2例无光感、1例光感、1例数指,3例手动、1例0.12。末次随访时最终5例因眼部感染未控制行眼内容摘除术,3例保留视力:1例光感,1例手动,1例0.3+。改进诊疗模式前的4例全部行眼内容摘除术,其中1例因肺炎克雷伯菌侵及脑脊液,引起中枢神经系统感染而死亡。改进诊疗模式后仅1例行眼内容摘除术,3例保留眼球,无一例死亡且肝脓肿全部治愈未扩散。结论首诊眼科的EKPE患者原发灶多为肝脓肿,多学科诊疗模式可改善全身和眼部预后。Objective To analyze the clinical characteristics and efficacy of patients with endogenous Klebsiella pneumoniae endophthalmitis(EKPE)at the first ophthalmology visit.Methods This was a retrospective case series study.The clinical data of 8 patients(8 eyes)with EKPE who were first-visit in ophthalmology in Northern Jiangsu People’s Hospital from Sep.2010 to Mar.2022 were analyzed.Depending on the severity of ocular conditions,8 patients underwent intravitreal drug injection,vitrectomy,or evisceration.Four cases had received multidisciplinary joint diagnosis and treatment model since 2019.The primary focus and systemic and ocular treatment plans as well as the outcomes for patients with EKPE before and after the implementation of the improved diagnostic and treatment model were analyzed.The follow-up time was from 1 month to 2 years after treatment.Results The primary focus in all 8 patients was liver abscess.The best corrected visual acuity at initial diagnosis was:2 cases with no light perception,1 case with light perception,1 case with counting fingers,3 cases with hand motion,and 1 case with 0.12.At the final follow-up,5 cases ultimately underwent evisceration due to uncontrollable ocular infection,with 3 cases retaining vision:1 case with light perception,1 case with hand motion,and 1 case with 0.3+.Before improvement of the diagnostic and treatment model,all 4 cases underwent evisceration.One case died due to Klebsiella pneumoniae invading the cerebrospinal fluid,causing central nervous system infection.After the improvement of the diagnostic and treatment model,only 1 case underwent evisceration,3 cases preserved the eyeball,and there were no deaths,and all liver abscesses were completely cured without spreading.Conclusion The primary lesion of EKPE patients is often liver abscess.The multidisciplinary treatment model can improve the systemic and ocular prognosis for patients with EKPE who present initially to the ophthalmology department.

关 键 词：眼内炎 内源性 肺炎克雷伯性 眼科 首诊 模式 诊疗 联合 多学科 

分 类 号：R771[医药卫生—眼科]