Bali E, Huyghe Ph, Caspers L, Libert J
Dept. of Ophthalmology, C.H.U. St Pierre-Brugmann U.L.B. Brussels, Belgium.
Bull Soc Belge Ophtalmol. 2003(288):9-14.
To evaluate the role of pars plana vitrectomy (PPV) and silicone oil injection in the treatment strategy of severe endophthalmitis.
This study analyses a retrospective case series of 34 patients with signs and symptoms of severe endophthalmitis with visual acuity limited to light perception. All underwent PPV with intraocular injection of antibiotics (IOAB), together with topical and oral antibiotics. In 10 patients (group 1), this treatment alone was sufficient to control infection. In 10 other patients (group 2) with the same initial treatment, a new vitrectomy was needed: 8 because of retinal detachment, 2 because of persistent infection. In 2 patients (group 3), initially treated with PPV and IOAB, a second vitrectomy with IOAB and silicone oil tamponade was needed to stop infection. In 12 patients (group 4), with the worse prognosis related to the severity of infection and/or to associated retinal necrosis, PPV, IOAB and silicone oil tamponade were conducted at first surgery. Final anatomic status and visual acuity were assessed to compare the effectiveness of these different treatments.
In 22 patients (group 1, 2 and 3) treated initially without silicone oil, 12 patients (55%) needed further surgery, either for persistent infection or retinal detachment. Twelve patients (group 4) treated at first with silicone oil had a rapid control of the infectious process and better anatomical results with this procedure only. Final visual acuity was also better in the silicone oil groups (group 3 and 4) than in the non silicone groups (group 1 and 2).
These results suggest that silicone oil tamponade might be beneficial in the treatment strategy of severe endophthalmitis.
评估玻璃体切除术（PPV）联合硅油注入在严重眼内炎治疗策略中的作用。
本研究分析了34例有严重眼内炎体征和症状且视力仅存光感的患者的回顾性病例系列。所有患者均接受了玻璃体切除术及眼内注射抗生素（IOAB），同时联合局部及口服抗生素治疗。10例患者（第1组），仅这种治疗就足以控制感染。另外10例患者（第2组）接受相同的初始治疗后，需要再次进行玻璃体切除术：8例是因为视网膜脱离，2例是因为感染持续存在。2例患者（第3组）最初接受了玻璃体切除术及眼内注射抗生素治疗，需要再次进行玻璃体切除术、眼内注射抗生素并联合硅油填塞以控制感染。12例患者（第4组），由于感染严重程度和/或相关视网膜坏死导致预后较差，在首次手术时进行了玻璃体切除术、眼内注射抗生素并联合硅油填塞。评估最终的解剖状况和视力以比较这些不同治疗方法的有效性。
在最初未使用硅油治疗的22例患者（第1组、第2组和第3组）中，12例患者（55%）因感染持续或视网膜脱离需要进一步手术。最初接受硅油治疗的12例患者（第4组）仅通过该手术就迅速控制了感染过程并取得了更好的解剖结果。硅油治疗组（第3组和第4组）的最终视力也优于非硅油治疗组（第1组和第2组）。
这些结果表明，硅油填塞在严重眼内炎的治疗策略中可能有益。
