Majji A B, Jalali S, Das T, Gopinathan U
Retina Vitreous Services, L.V. Prasad Eye Institute, Hyderabad, India.
Eye (Lond). 1999 Oct;13 ( Pt 5):660-5. doi: 10.1038/eye.1999.179.
To determine the effects of intravitreal dexamethasone in patients with exogenous fungal endophthalmitis.
Twenty cases of culture-proven exogenous fungal endophthalmitis following cataract surgery (11/20) and trauma (9/20) were retrospectively analysed for pre- and postoperative visual acuity, anterior chamber and vitreous inflammation and media clarity. All patients were managed with pars plana vitrectomy with intravitreal amphotericin B and oral ketoconazole with (steroid plus group) or without (steroid minus group) intravitreal dexamethasone. Results were analysed by Fisher's exact test.
Following vitrectomy 9 of 20 patients (45%) achieved a visual acuity better than counting fingers at 3 m. No statistically significant difference was observed in anatomical and visual outcome between the steroid plus and steroid minus groups, though the number of patients with favourable visual outcome was greater in the steroid plus group. Rate of clearance of inflammation was better in the steroid plus group (40 +/- 15.5 vs 55 +/- 8.6 days). All patients (6/20) with pre-operative vision better than counting fingers showed good anatomical and visual outcome in both groups.
The results of our retrospective study suggest that steroids may be beneficial in promoting faster clearance of inflammation in fungal endophthalmitis. Sensitivity of the fungi to antifungals, dose and timing of steroid and institution of effective antifungal medication prior to the use of steroids are the essential factors which need to be examined further in a prospective manner.
确定玻璃体内注射地塞米松对外源性真菌性眼内炎患者的影响。
回顾性分析20例经培养证实的白内障手术后（11/20）和外伤后（9/20）外源性真菌性眼内炎患者的术前和术后视力、前房和玻璃体炎症以及介质清晰度。所有患者均接受玻璃体切除术，术中玻璃体内注射两性霉素B，并口服酮康唑，部分患者（类固醇加用组）同时玻璃体内注射地塞米松，部分患者（类固醇未用组）未注射。结果采用Fisher精确检验进行分析。
玻璃体切除术后，20例患者中有9例（45%）视力恢复到优于3米数指。类固醇加用组和类固醇未用组在解剖学和视觉结果方面未观察到统计学上的显著差异，尽管类固醇加用组中视力良好的患者数量更多。类固醇加用组的炎症清除率更高（40±15.5天对55±8.6天）。所有术前视力优于数指的患者（6/20）在两组中均显示出良好的解剖学和视觉结果。
我们的回顾性研究结果表明，类固醇可能有助于促进真菌性眼内炎炎症的更快清除。真菌对抗真菌药物的敏感性、类固醇的剂量和时机以及在使用类固醇之前使用有效的抗真菌药物是需要在前瞻性研究中进一步研究的关键因素。
