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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2018, Vol. 08 ›› Issue (01) : 9 -14. doi: 10.3877/cma.j.issn.2095-2007.2018.01.002

所属专题： 文献；

论著

白内障摘除联合人工晶状体植入术后急性感染性眼内炎的临床观察
陈倩茵1, 张静琳1, 林振德2,†(), 武哲明2, 林慧敏1   
  1. 1. 510060　广州爱尔眼科医院眼底病科
    2. 510060　广州爱尔眼科医院白内障科
  • 收稿日期:2018-02-03 出版日期:2018-02-28
  • 通信作者: 林振德
  • 基金资助:
    广东省医学科学技术研究基金(C2017028); 广州市卫生局医学卫生科技项目(20171A011332)

Clinical observation of acute infective endophthalmitis after cataract extraction combined with intraocular lens implantation

Qianyin Chen1, Jinglin Zhang1, Zhende Lin2,†(), Zheming Wu2, Huimin Lin1   

  1. 1. Department of Fundus Disease, Guangzhou Aier Eye Hospital, Guangzhou 510060, China
    2. Department of Cataract, Guangzhou Aier Eye Hospital, Guangzhou 510060, China
  • Received:2018-02-03 Published:2018-02-28
  • Corresponding author: Zhende Lin
  • About author:
    Corresponding author: Lin Zhende, Email:
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引用本文：

陈倩茵, 张静琳, 林振德, 武哲明, 林慧敏. 白内障摘除联合人工晶状体植入术后急性感染性眼内炎的临床观察[J]. 中华眼科医学杂志(电子版), 2018, 08(01): 9-14.

Qianyin Chen, Jinglin Zhang, Zhende Lin, Zheming Wu, Huimin Lin. Clinical observation of acute infective endophthalmitis after cataract extraction combined with intraocular lens implantation[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2018, 08(01): 9-14.

目的

探讨白内障摘除联合人工晶状体(IOL)植入术后急性感染性眼内炎的治疗策略。

方法

收集2011至2017年广州爱尔眼科医院收治并诊断为白内障摘除联合IOL植入术后发生急性感染性眼内炎的9例患者的临床资料。其中，在广州爱尔眼科医院进行白内障手术后发生眼内炎的患者1例，在基层医院行白内障手术后发生眼内炎的转诊患者8例。查阅患者的视力、眼压、眼前节、眼部B超扫描等检查结果。对患者行玻璃体切除术(PPV)，并依据患者的感染情况行IOL取出＋硅油填充术。手术中常规取前房液和玻璃体液进行细菌和真菌培养。

结果

在9例患者中，糖尿病患者1例，高血压患者2例，其余无长期全身疾病。本文中所有患者发生急性感染性眼内炎的时间均在白内障手术后1～9 d，表现为术眼剧痛、视力急剧下降、结膜充血水肿、角膜不同程度水肿、房水混浊伴或不伴前房积脓及出现前房渗出膜等症状。眼部B超检查结果显示患者的玻璃体混浊，眼底窥不见。在9例急性感染性眼内炎患者中，有8例患者及时进行PPV治疗，1例患者由于角膜混浊未能进行完整的PPV；7例患者术前曾行前房冲洗及取材行病理涂片，6例患者于PPV前进行玻璃体腔内注射万古霉素；术后早期有3例患者取出IOL联合硅油填充术，其余6例患者保留IOL以及眼内注药，无填充硅油。9例患者中有7例患者术后视力较术前有所提高，其中最佳矫正视力在0.01～0.09的有2例，在0.1～0.3的有3例，在0.3～0.5的有2例，1例患者术后视力无提高，1例患者由于感染不能控制，进行眼内容物剜除术。

结论

PPV是白内障摘除术后急性感染性眼内炎有效控制感染的治疗方法。对于角膜条件相对较好的眼内炎患者积极行PPV是保留患者视功能的关键。

关键词: 急性感染性眼内炎, 白内障摘除术, 玻璃体切除术
Objective

To observe and discuss the treatment strategy of acute infective endophthalmitis after cataract extraction combined with intraocular lens (IOL) implantation.

Methods

The clinical data of 9 patients with acute infectious endophthalmitis after cataract extraction and IOL implantation were collected from 2011~2017 years′ ophthalmology hospital in Guangzhou. Among them, there was one case of endophthalmitis after cataract surgery in Guangzhou Eye Hospital, 8 cases of endophthalmitis referral patients after cataract surgery in primary hospitals.Check the results of the patient′s visual acuity, intraocular pressure, anterior segment, ocular ultrasound scan and so on. The patients were treated with parsplana vitrectomy (PPV) and the patients were infected with IOL and silicone oil filling. During the operation, the anterior chamber fluid and the glass fluid were given to the bacteria and fungi.

Results

Among the 9 patients, there were 1 patients with diabetes, 2 patients with hypertension, and the rest had no long-term systemic disease. All patients in this acute infectious endophthalmitis after cataract surgery in time was 1~9 days, showed a sharp decline in visual acuity, eye pain, conjunctival hyperemia and edema, corneal edema of different degrees, aqueous humor with/without hypopyon and anterior chamber exudation membrane etc.. The results of ocular ultrasound examination revealed the vitreous opacity of the patient and the fundus of the eyes were not seen. In 9 cases, 8 cases were treated by full vitrectomy and one case of full vitrectomy was not performed due to corneal opacity. 6 cases were practiced intravitreal injection before vitrectomy. In the first 3 cases were taken out with IOL and silicone tamponade, but the other 6 cases were not necessary of IOL removal and silicone tamponade. Postoperative visual acuity was improved in 7 of 9 cases. Visual acuity 0.01~0.09 were in 2 cases, 0.1~0.3 were in 3 cases and 0.3~0.5 were in 2 cases. one case with no improvement of vision and 1 case was practiced evisceration due to infection spreading.

Conclusion

PPV is an effective treatment for acute infectious endophthalmitis after cataract surgery. It plays an important role on controlled the infection and retained the visual function of patients, especially in well corneal condition cases.

Key words: Acute infective endophthalmitis, Cataract removal, Parsplana vitrectomy
表1 白内障摘除联合IOL植入术后急性感染性眼内炎患者的一般资料
病例编号 性别 年龄(岁) 就诊时间(年) 术后眼内炎发生时间(d) 术前视力 眼部情况
角膜水肿 前房 玻璃体混浊
1 男 75 2011 7 光感 ＋ 前房积脓1 mm 有
2 男 71 2012 2 手动/眼前 ＋＋ 前房积脓1.5 mm 有
3 男 63 2013 9 指数/10 cm ＋ 前房积脓1.5 mm 有
4 女 73 2016 4 手动/眼前 ＋ 房水混浊，炎症渗出 有
5 男 63 2016 5 手动/眼前 ＋ 房水混浊，炎症渗出 有
6 男 68 2017 4 手动/眼前 ＋ 房水混浊，炎症渗出 有
7 男 71 2017 2 指数/10 cm ＋ 房水混浊 有
8 男 67 2017 1 指数/30 cm ＋ 房水混浊 有
9 男 67 2017 1 手动/眼前 ＋＋＋ 房水混浊 有
图1 第9例白内障术后眼内炎患者的眼前节裂隙灯显微镜检查图像　A图为首诊时的图像，可见球结膜充血水肿，角膜白色混浊水肿，前房积脓；B图为玻璃体联合注药后8 d的图像，可见球结膜充血水肿减轻，角膜水肿改善，前房积脓减少
图2 白内障术后眼内炎患者首诊时的眼前节裂隙灯显微镜检查图像　A图为第1例患者的图像，可见球结膜充血，角膜颞侧白色炎症混浊，角膜下方血管翳，仅隐约透见上方虹膜和IOL；B图为第2例患者的图像，可见球结膜充血，角膜水肿，前房积脓
表2 白内障摘除联合IOL植入术后急性感染性眼内炎患者的治疗情况及视力情况
病例编号 治疗情况 术后视力
术前曾行前房冲洗 术前行玻璃体腔内注药 手术情况 IOL情况
1 有 无 PPV＋硅油填充 取出IOL —
2 无 无 PPV＋硅油填充 取出IOL 0.01
3 无 无 PPV＋硅油填充 取出IOL 指数/10 cm
4 有 有 PPV＋眼内注药术 保留IOL 0.40
5 有 有 PPV＋眼内注药术 保留IOL 0.15
6 有 有 PPV＋眼内注药术 保留IOL 0.08
7 有 有 PPV＋眼内注药术 保留IOL 0.40
8 有 有 PPV＋眼内注药术 保留IOL 0.20
9 有 有 眼内注药术 保留IOL 手动/30 cm
[1]
Yao K, Zhu Y, Zhu Z, et al. The incidence of postoperative endophthalmitis after cataract surgery in China: a multicenter investigation of 2006－2011[J]. Bri J Ophthalmol, 2013, 97(10):1312-1317.
[2]
Hegazy HM, Kivilcim M, Peyman GA, et al. Evaluation of toxicity of intravitreal ceftazidime, vancomycin, and ganciclovir in a silicone oil－filled eye[J]. Retina, 1999, 19(6):553-557.
[3]
Sheng Y, Sun W, Gu Y, et al. Endophthalmitis after cataract surgery in China, 1995－2009[J]. J Cataract Refract Surg, 2011, 37(9):1715-1722.
[4]
Durand ML, Miller JW, Young LH. Endophthalmitis[J]. Clinical Microbiology & Infection, 2013, 19(3):227-234.
[5]
Cao H, Zhang L, Li L, et al. Risk Factors for Acute Endophthalmitis following Cataract Surgery: A Systematic Review and Meta－Analysis[J]. PloS One, 2013, 8(8):e71731.
[6]
Schmier J, Hulme－Lowe C, Covert D, et al. An updated estimate of costs of endophthalmitis following cataract surgery among Medicare patients: 2010－2014[J]. Clin Ophthalmol, 2016, 10(2016):2121-2127.
[7]
Friling E, Lundström M, Stenevi U, et al. Six－year incidence of endophthalmitis after cataract surgery: Swedish national study[J]. J Cataract Refract Surg, 2013, 39(1):15-21.
[8]
Chiquet C, Boisset S, Pechinot A, et al. Massilia timonae as cause of chronic endophthalmitis following cataract surgery[J]. J Cataract Refract Surg, 2015, 41(8):1778-1780.
[9]
Matsuura K, Miyoshi T, Suto C, et al. Efficacy and safety of prophylactic intracameral moxifloxacin injection in Japan[J]. J Cataract Refract Surg, 2013, 39(11):1702-1706.
[10]
Lundström M, Wejde G, Stenevi U, et al. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location[J]. Ophthalmology, 2007, 114(5):866-870.
[11]
Hatch W, Cernat GD, Devenyi R, et al. Risk factors for acute endophthalmitis after cataract surgery: a population－based study[J]. Ophthalmology, 2009, 116(3):425-430.
[12]
Freeman EE, Roygagnon MH, Fortin E, et al. Rate of endophthalmitis after cataract surgery in Quebec, Canada, 1996－2005[J]. Arch Ophthalmol, 2010, 128(2):230-234.
[13]
Braga－Mele R, Chang DF, Henderson BA, et al. Intracameral antibiotics: Safety, efficacy, and preparation[J]. J Cataract Refract Surg, 2014, 40(12):2134-2142.
[14]
中华医学会眼科学分会白内障及人工晶状体学组. 我国白内障摘除手术后感染性眼内炎防治专家共识(2017年)[J]. 中华眼科杂志，2017, 53(11):810-813.
[15]
Jabbarvand M, Hashemian H, Khodaparast M, et al. Endophthalmitis Occurring after Cataract Surgery: Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic Features, and Risk Factors[J]. Ophthalmology, 2016, 123(2):295-301.
[16]
West ES, Behrens A, Mcdonnell PJ, et al. The incidence of endophthalmitis after cataract surgery among the U．S. Medicare population increased between 1994 and 2001[J]. Ophthalmology, 2005, 112(8):1388-1394.
[17]
Li J, Morlet N, Ng JQ, et al. Significant Nonsurgical Risk Factors for Endophthalmitis after Cataract Surgery: EPSWA Fourth Report[J]. Invest Ophthalmol Vis Sci, 2004, 45(5):1321-1328.
[18]
Lundström M, Friling E, Montan P. Risk factors for endophthalmitis after cataract surgery: Predictors for causative organisms and visual outcomes[J]. J Cataract Refract Surg, 2015, 41(11):2410-2416.
[19]
Norregaard JC, Thoning H, Bernthpetersen P, et al. Risk of endophthalmitis after cataract extraction: results from the International Cataract Surgery Outcomes study[J]. Am J Ophthalmol, 1997, 123(8):689-693.
[20]
Barry P, Seal D, Gettinby G, et al. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors[J]. J Cataract Refract Surg, 2007, 33(6):978-988.
[21]
Keay L, Gower EW, Cassard SD, et al. Postcataract Surgery Endophthalmitis in the United States: Analysis of the Complete 2003 to 2004 Medicare Database of Cataract Surgeries[J]. Ophthalmology, 2012, 119(5):914-922.
[22]
Ahmed Y, Scott IU, Pathengay A, et al. Povidone－Iodine for Endophthalmitis Prophylaxis[J]. Am J Ophthalmol, 2014, 157(3):503-504.
[23]
Scott WJ. Povidone－iodine antisepsis for cataract surgery and ophthalmic procedures[J]. Am J Ophthalmol. 2011, 151(5):914-915.
[24]
Tan CSH, Lim LW, Kai XC. Incidence of postoperative endophthalmitis with the use of povidone－iodine[J]. J Cataract Refract Surg, 2015, 41(4):903-904.
[25]
Shorstein NH, Winthrop KL, Herrinton LJ. Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department[J]. J Cataract Refract Surg, 2013, 39(1):8-14.
[26]
Rodríguezcaravaca G, Garcíasáenz MC, Villardelcampo MC, et al. Incidence of endophthalmitis and impact of prophylaxis with cefuroxime on cataract surgery[J]. J Cataract Refract Surg, 2013, 39(9):1399-1403.
[27]
Herrinton LJ, Shorstein NH, Paschal JF, et al. Comparative Effectiveness of Antibiotic Prophylaxis in Cataract Surgery[J]. Ophthalmology, 2016, 123(2):287-294.
[28]
Fintelmann RE, Naseri A. Prophylaxis of postoperative endophthalmitis following cataract surgery: current status and future directions[J]. Drugs, 2010, 70(11):1395-1409.
[29]
Wejde G, Montan P, Lundström M, et al. Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999－2001[J]. Acta Ophthalmologica, 2005, 83(1):7-10.
[30]
García－Sáenz MC, Arias－Puente A, Rodríguez－Caravaca G, et al. Effectiveness of intracameral cefuroxime in preventing endophthalmitis after cataract surgery Ten－year comparative study[J]. J Cataract Refract Surg, 2010, 36(2):203-207.
[31]
Yuwaiman P, Morgan SJ, Hildreth AJ, et al. Efficacy of intracameral and subconjunctival cefuroxime in preventing endophthalmitis after cataract surgery[J]. J Cataract Refract Surg, 2008, 34(3):447-451.
[32]
Schwartz SG, FH Jr, Grzybowski A, et al. Intracameral Antibiotics and Cataract Surgery: Endophthalmitis Rates, Costs, and Stewardship[J]. Ophthalmology, 2016, 123(7):1411-1413.
[33]
Comer GM, Miller JB, Schneider EW, et al. Intravitreal daptomycin: a safety and efficacy study[J]. Retina, 2011, 31(6):1199-1206.
[34]
Doft BH, Kelsey SF, Wisniewski S, et al. Treatment of endophthalmitis after cataract extraction[J]. Retina, 1994, 14(4):297-304.
[35]
Gower EW, Keay LJ, Stare DE, et al. Characteristics of Endophthalmitis after Cataract Surgery in the United States Medicare Population[J]. Ophthalmology, 2015, 122(8):1625-1632.
[36]
Almanjoumi AM, Combey A, Romanet JP, et al. 23－gauge transconjunctival sutureless vitrectomy in treatment of post－operative endophthalmitis[J]. Graefe′s Archive for Clinical and Experimental Ophthalmology, 2012, 250(9):1367-1371.
[37]
Altan T, Kapran Z, Eser I, et al. Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25－gauge and 20－gauge techniques[J]. Japanese Journal of Ophthalmology, 2009, 53(5):506-511.
[38]
Rejdak R, Choragiewicz T, Kalinowska A, et al. Vancomycin in infusion during vitrectomy in surgical treatment of acute postoperative and posttraumatic endophthalmitis[J]. Bmc Infectious Diseases, 2016, 16(1):496.
[39]
Pavan PR, Oteiza EE, Hughes BA, et al. Exogenous endophthalmitis initially treated without systemic antibiotics[J]. Ophthalmology, 1994, 101(7):1289-1296.
[40]
Listed N. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group[J]. Arch Ophthalmol, 1995, 113(12):1479-1496.
[41]
Barry P, Gardner S, Seal D, et al. Clinical observations associated with proven and unproven cases in the ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery[J]. J Cataract Refract Surg, 2009, 35(9):1523-1531.
[42]
Yan H, Li J. An experimental study on antimicrobial activity of silicone oil in vitro[J]. Ophthalmologica, 2008, 222(4):245-248.
[43]
Yan H, Li J. Experimental study on antiviral activity of silicone oil in vitro[J]. Graefe′s archive for clinical and experimental ophthalmology, 2008, 246(9):1285-1289.
[44]
颜华，陈松，张静楷，等. 白内障术后眼内炎保留人工晶状体的治疗[J]. 中华眼科杂志，2009，45(8):684-687.
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