【摘要】 目的:观察玻璃体切除联合玻璃体腔内注射万古霉素治疗眼内炎的疗效。方法:回顾性分析眼内炎患者30例30眼,观察其玻璃体细菌、真菌培养结果,经玻璃体切除后玻璃体腔内注射万古霉素,观察其眼部情况、最佳矫正视力及眼部并发症。结果:其中29眼(97%)控制了炎症,无视网膜脱离等眼底并发症,保留了眼球。1眼(3%)术后发展为全眼球炎而行眼球摘除。19眼(63%)视力比术前提高,7眼(23%)视力无变化,4眼(13%)视力比术前下降。结论:玻璃体切除联合玻璃体腔内注射万古霉素能够有效治疗眼内炎。
【关键词】 眼内炎;玻璃体切除;万古霉素
Vitrectomy combined with intravitreal antibiotics injection for endophthalmitis
Yu Di1, YiOu Zhang2, Yang Yang1, HongWei Yang1, Yan Lu1, XiaoLong Chen 1
Foundation item: Education Department Foundation of Liaoning Province, China(No.20060994)
1Department of Ophthalmology,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning Province, China;2Graduate school of China Medical University,Shenyang 110001, Liaoning Province, China
Correspondence to: Yu Di. Department of Ophthalmology,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning Province, China. zhangyiou78@126.com
Received:20100705 Accepted:20100714
Abstract
AIM: To observe the clinical effects of vitrectomy combined with intravitreal injection of vancomycin for endophthalmitis.
METHODS: We carried out retrospective analysis of endophthalmitis in 30 cases 30 eyes. We observed the culture results of vitreous bacteria and fungi. All cases were injected vancomycin into vacuum vitreous after vitrectomy.We further observed the situation in the eyes, including the bestcorrected visual acuity and complications.
RESULTS: During the followup time, the endophthalmictis in 29 eyes (97%) were controlled without retinal complication. One case of 1 eye (3%) was panophthalmitis and removal of eye ball. Visual acuities of 19 eyes (63%) were improved, of 7 eyes(23%)were same, of 4 eyes(13%) were decreased.
CONCLUSION: Vitrectomy combined with intravitreal injection of vancomycin is effective in treating endophthalmitis.
KEYWORDS: endophthalmitis; vitrectomy; vancomycin
Di Y, Zhang YO, Yang Y, et al. Vitrectomy combined with intravitreal antibiotics injection for endophthalmitis. Int J Ophthalmol(Guoji
Yanke Zazhi) 2010;10(9):17831784
眼内炎[1]是一种严重的眼内感染,为葡萄膜与视网膜的化脓性炎症。由于眼内屏障影响药物穿透,眼内结构易受细菌、真菌、病毒及其毒素所致炎症的损害,各种方法常较难控制感染的发展,严重损害眼球组织及视功能,导致患眼失明。玻璃体切除联合玻璃体腔内注射万古霉素,为严重眼内炎提供了行之有效的治疗方案。
1对象和方法
1.1对象
回顾分析200503/201003我院采用玻璃体切除联合玻璃体腔内注射万古霉素治疗眼内炎30例30眼,其中男25例25眼,女5例5眼,年龄25~83(平均54)岁,其中眼外伤引起眼内炎19眼(63%),白内障术后引起5眼(17%),6眼无诱因下出现眼内炎(20%)。穿通伤合并球内异物7眼,眼内炎合并白内障9眼,合并视网膜脱离15眼,所有病例就诊时均有眼部高度充血、角膜水肿、前房积脓, B超均示玻璃体呈絮状混浊。视力急剧下降,其中术前视力无光感者4眼,仅光感者6眼,手动/眼前者9眼,指数/眼前者11眼。
1.2方法
诊断标准:有眼球穿通伤、内眼手术和内源性感染病史,临床症状:视力急剧减退、剧痛、畏光、流泪等症状和眼部高度充血、角膜水肿混浊、前房积脓、玻璃体内渗出、灰白色混浊以及眼内呈灰黄色反光等。 B超均示玻璃体呈絮状混浊。最有价值和最可靠的方法是眼内液的微生物学检查[2],包括抽取玻璃体做细菌、真菌培养检查,以确定眼内炎的病原性质并做药敏试验,以便使用最有效的抗生素。所有病例入院后均及时作睫状体平坦部闭合玻璃体切除术,术中所用的灌注液中加万古霉素5mg/500mL,清除玻璃体腔絮状物、脓液,混浊玻璃体及机化物,9眼行白内障摘除及前房脓性物清除冲洗,5眼人工晶状体取出,7眼异物取出,术中发现视网膜脱离的15眼患者接受激光光凝术及硅油或C3F8充填术。其中硅油充填11眼,C3F8充填4眼。万古霉素10mg/mL玻璃体腔注射。术后联合全身抗生素及激素使用,眼局部抗炎对症治疗。术后根据细菌培养和药物敏感试验结果,及时调整抗生素种类。怀疑真菌感染者禁用激素治疗。图1 偶发分枝杆菌 A:革兰氏染色;B:抗酸染色。
2结果
术后视力:19眼(63%)视力比术前提高,7眼(23%)视力无变化,4眼(13%)视力比术前下降。术后矫正视力≥0.1者9眼,0.05~0.1者8眼,0.05者5眼,手动~指数/眼前者3眼,仅光感者3眼,无光感者2眼。病原体检查:所有患者均行玻璃体腔液培养。培养阳性者12眼。金黄色葡萄球菌4眼,表皮葡萄球菌4眼,真菌2眼,绿脓杆菌1眼,偶发分枝杆菌1眼(图1)。术后并发症:除偶发分枝杆菌1眼发展为全眼球炎行眼球摘除外,其余患者均能保留眼球,无视网膜裂孔、视网膜脱离、眼球萎缩等并发症。评价标准:术后视力以末次随访最佳视力(best corrected visual acuity,BCVA)为依据。BCVA≥0.05脱盲作为疗效评价的标准[3]。
统计学分析:所有数据采用SPSS 13.0,计数资料采用χ2检验,以α=0.05为水准。
[1] [2] 下一页 |