Manku Harkiran, McCluskey Peter
Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Clin Exp Ophthalmol. 2005 Dec;33(6):604-10. doi: 10.1111/j.1442-9071.2005.01104.x.
To assess whether the results of microbial and cytological investigations of vitreous biopsy specimens are useful in the management of patients with intraocular inflammation.
A retrospective review of the medical records of 59 consecutive patients from consulting rooms, outpatient clinics and inpatient consultation who underwent intravitreal sampling between January 1997 and December 2003. Results of the biopsies were examined to determine if they altered management of the patient.
The clinical diagnosis was correct in 37 of 59 patients (62.7%) with ocular inflammation. The organism was identified in 50% (7/14) of vitreous biopsies in patients with postoperative endophthalmitis. Of patients with endogenous bacterial endophthalmitis 16.7% (1/6) had the diagnosis confirmed by vitreous tap and 83.3% (5/6) had positive cultures from other sites that provided the diagnosis. Of the fungal endophthalmitis 80% (4/5) grew the fungus from the vitreous biopsy. Viral polymerase chain reaction identified the causative organism in 87.5% (7/8) of patients with clinical diagnosis of viral infection. 30.8% (4/13) vitreous biopsies in patients with clinically suspected masquerade syndromes were diagnosed as lymphoma. Vitreous biopsy results altered management significantly in seven (11.9%) patients. These patients included toxoplasmosis that was thought to be viral retinitis; malignant melanoma thought to be fungal endophthalmitis; chronic inflammation secondary to retinal detachment that was thought to be a neoplasm; three patients with infective endophthalmitis thought to be idiopathic uveitis and a patient with known lung carcinoma thought to have metastases who had lymphoma. In 67.8% (40/59) the vitreous sample helped to either confirm the diagnosis or exclude an infective cause. Complications from vitrectomy were hypotony (1/29) and retinal detachment (1/29).
Clinical diagnosis based on examination findings and vitreous biopsy is highly accurate. Vitreous sampling altered the management of seven of 59 patients. Vitreous biopsy is a safe and useful method for diagnosing and excluding malignancy and infection in patients with ocular inflammation. Viral polymerase chain reaction is highly sensitive and accurate. The sensitivity of microbiological culture techniques for bacteria and fungi limits their usefulness.
评估玻璃体活检标本的微生物学和细胞学检查结果对眼内炎患者治疗的指导作用。
回顾性分析1997年1月至2003年12月期间59例在诊室、门诊及住院会诊时接受玻璃体取样患者的病历。检查活检结果以确定其是否改变了患者的治疗方案。
59例眼内炎患者中，37例（62.7%）临床诊断正确。术后眼内炎患者中，50%（7/14）的玻璃体活检鉴定出病原体。在细菌性内源性眼内炎患者中，16.7%（1/6）通过玻璃体穿刺确诊，83.3%（5/6）通过其他部位培养阳性确诊。真菌性眼内炎患者中，80%（4/5）的玻璃体活检培养出真菌。病毒聚合酶链反应在临床诊断为病毒感染的患者中，87.5%（7/8）鉴定出病原体。临床怀疑伪装综合征的患者中，30.8%（4/13）的玻璃体活检诊断为淋巴瘤。玻璃体活检结果使7例（11.9%）患者的治疗方案发生显著改变。这些患者包括被误诊为病毒性视网膜炎的弓形虫病；被误诊为真菌性眼内炎的恶性黑色素瘤；被误诊为肿瘤的视网膜脱离继发慢性炎症；3例被误诊为特发性葡萄膜炎的感染性眼内炎患者；以及1例已知肺癌但被误诊为转移瘤而实际为淋巴瘤的患者。67.8%（40/59）的玻璃体样本有助于确诊或排除感染性病因。玻璃体切割术的并发症为低眼压（1/29）和视网膜脱离（1/29）。
基于检查结果和玻璃体活检的临床诊断准确性高。玻璃体取样改变了59例患者中7例的治疗方案。玻璃体活检是诊断和排除眼内炎患者恶性肿瘤和感染的安全有效方法。病毒聚合酶链反应高度敏感且准确。细菌和真菌的微生物培养技术敏感性限制了其应用价值。
