翼状胬肉切除术后感染性巩膜炎的管理

Management of infectious scleritis after pterygium excision.

作者信息

Huang F C, Huang S P, Tseng S H

机构信息

Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.

出版信息

Cornea. 2000 Jan;19(1):34-9. doi: 10.1097/00003226-200001000-00008.

DOI:10.1097/00003226-200001000-00008

PMID:10632006

Abstract

PURPOSE

We sought to describe the clinical features, responsible pathogens, management, and prognosis of infectious scleritis after pterygium excision.

METHODS

A retrospective study through review of medical records of patients diagnosed with infectious scleritis after pterygium excision over a 10-year period at our institution.

RESULTS

A total of 16 cases of infectious scleritis after pterygium excision was identified. Among them, eight were associated with sclerokeratitis, and six had multifocal scleral nodules with subconjunctival abscesses. Culture results were positive in 15 (93.8%) cases. Pseudomonas was isolated in 13 (81.3%) patients, fungus in three (18.8%), and two had a mixed growth (12.5%). Based on the in vitro susceptibility test, four (31%) Pseudomonas isolates were resistant to gentamicin, whereas all isolates were sensitive to amikacin. During the course of treatment, eight cases were complicated by vitreous opacity, four developed glaucoma, four had serous retinal or choroidal detachment, and two had secondary cataract. Scleral infection recurred in two patients after cessation of therapy. Among the nine patients treated with medical therapy, two eyes were enucleated, whereas only two attained a visual acuity of > or =2/200 at the end of the follow-up period. On the other hand, seven patients had combined antibiotic therapy and surgical debridement. The number of surgical debridement ranged from one to three, with an average of 1.4. In this combined-treatment group, only one patient required enucleation, and five cases attained a visual acuity of > or =2/200. The duration of hospitalization for patients with combined treatment was 21.2+/-4.8 days compared with the 28.4+/-5.0 days for those with medical treatment alone (p = 0.035).

CONCLUSION

Surgical debridement in combination with appropriate antimicrobial therapy shortens the course of treatment and improves the visual outcome of severe infectious scleritis after pterygium excision.

摘要

目的

我们试图描述翼状胬肉切除术后感染性巩膜炎的临床特征、致病病原体、治疗方法及预后。

方法

通过回顾我院10年间诊断为翼状胬肉切除术后感染性巩膜炎患者的病历进行一项回顾性研究。

结果

共确诊16例翼状胬肉切除术后感染性巩膜炎。其中，8例合并硬化性角膜炎，6例有多发性巩膜结节伴结膜下脓肿。15例（93.8%）培养结果呈阳性。13例（81.3%）患者分离出铜绿假单胞菌，3例（18.8%）为真菌，2例有混合菌生长（12.5%）。根据体外药敏试验，4株（31%）铜绿假单胞菌分离株对庆大霉素耐药，而所有分离株对阿米卡星敏感。在治疗过程中，8例出现玻璃体混浊并发症，4例发生青光眼，4例有浆液性视网膜或脉络膜脱离，2例有继发性白内障。2例患者在治疗停止后巩膜感染复发。在接受药物治疗的9例患者中，2只眼被摘除，而在随访期末只有2例视力达到或高于2/200。另一方面，7例患者接受了联合抗生素治疗和手术清创。手术清创次数为1至3次，平均1.4次。在这个联合治疗组中，只有1例患者需要摘除眼球，5例视力达到或高于2/200。联合治疗患者的住院时间为21.2±4.8天，而单纯药物治疗患者为28.4±5.0天（p = 0.035）。