白内障术后感染性眼内炎的临床特点及治疗

Clinical characteristics and treatment of infective endophthalmitis after cataract surgery

doi:
10.3877/cma.j.issn.1674-1358.2017.03.012
摘要:
目的 探讨白内障术后感染性眼内炎的临床特点及治疗.方法 收集2012年1月至2016年1月于深圳市龙岗区人民医院和深圳市眼科医院诊治的20例(20只眼)白内障术后感染性眼内炎患者,20例患者均于表面麻醉下行万古霉素玻璃体内注药术,其中6例重症患者行玻璃体手术采用常规闭合三通道23 G玻璃体切除术联合硅油填充术,术后3~6个月酌情行硅油取出术,观察患者玻璃体切除术(第2次手术)术后1周及硅油取出术(第3次手术)术后1周的眼部疼痛、角膜混浊、前房脓性渗出物、玻璃体渗出、眼底情况等症状的改善,血常规有无异常;同时观察患者的最佳矫正视力.结果20例患者在第2次手术后,疼痛缓解,角膜混浊消失,前房脓性渗出物消失,玻璃体腔内透明,眼底可见视乳头界清,色淡红,视网膜平伏,黄斑中心凹反光可见.第3次手术后随访患者3~6个月症状无复发.第2次手术后1周及第3次手术后1周与第2次手术前的最佳矫正视力比较,差异均具有统计学意义(t=76.0、P=0.019,t=53.74、P=0.027).结论 白内障术后感染性眼内炎的患者术中及术后应选用万古霉素联合其他抗菌药物抗感染治疗,手术采用万古霉素玻璃体内注药术,重症患者联合玻璃体切除术及硅油填充术,术后患者症状显著改善,视力明显提高.
Abstract:
Objective To investigate the clincal characteristics and treatment of infective endophthalmitis after cataract surgery. Methods Total of 20 patients (20 eyes) with infective endophthalmitis after cataract surgery were selected from January 2012 to January 2016 in People's Hospital of Longgang District and Shenzhen Eye Hospital. All the 20 cases were accepted with insurface anesthesia of vancomycin intravitreal injection, 6 severe cases accepted vitreous body surgery with conventional closed three channel 23 G vitreous body resection surgery combined with silicone oil tamponade. Silicone oil removal was performed at 3-6 months after operation. The degree of eye pain, corneal opacity, anterior chamber purulent exudate, vitreous seepage, the improvement of symptoms such as eye condition, routine blood test of were investigated on patients with 1 week after vitrectomy (second operation) and 1 week after silicone oil (third operation), and investigated the best corrected visual acuity of patients. Results After the second operation, pain of 20 patients was relieved, keratopnea disappeared, preatrial purulent exudate disappeared, glass body was transparent; the eyes were visible at the base of the nipple, the pale was red, the retina was flat, and the center of the macula was visible. Patients following up for 3-6 months after the third operation were nonrecurrent. Compared with the second operation, the differences of the best orthodontic vision of 1 week after the second operation and 1 week after the third operation were all statistically significant (t = 76.0, P =0.019; t = 53.74, P = 0.027). Conclusions Patients with infectious endophthalmitis after cataract intraoperative and postoperative should choose vancomycin in combination with other antibacterial drugs to anti-infection, and vancomycin injection drug in vitreous surgery, vitrectomy and silicone oil filling should be adopted for severe cases, symptoms of patients after operation improved significantly, and eyesight had significantly improved.
作者 龙巧燕[1]    陈青山[2]    成洪波[2]    朱远飞[2]    刘姣[1]    陈玉华[1]    廖海兰[1]    赵春宁[3]
Author: Long Qiaoyan[1]    Chen Qingshan[2]    Cheng Hongbo[2]    Zhu Yuanfei[2]    Liu Jiao[1]    Chen Yuhua[1]    Liao Hailan[1]    Zhao Chunning[3]
作者单位
  1. 深圳市龙岗区人民医院眼科, 深圳市,518172
  2. 深圳市眼科医院眼科, 深圳市,508040
  3. 青岛市市立医院眼科, 青岛市,266071
刊 名: 中华实验和临床感染病杂志(电子版)   ISTIC
Journal: Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Version)
年,卷(期) 2017, 11(3)
分类号
关键词: 白内障术后 知识脉络    感染性眼内炎 知识脉络    治疗 知识脉络   
Keywords: Cataract surgery    Infective endophthalmitis    Treatment   
机标分类号
基金项目 深圳市龙岗区科技发展资金项目
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