Yang Chang-Sue, Tsai Hsien-Yang, Sung Chun-Sung, Lin Keng-Hung, Lee Fenq-Lih, Hsu Wen-Ming
Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Ophthalmology. 2007 May;114(5):876-80. doi: 10.1016/j.ophtha.2006.12.035.
To study risk factors, clinical features, treatment, and visual outcomes in patients with endogenous Klebsiella pneumoniae endophthalmitis (EKE) associated with K. pneumoniae-induced pyogenic liver abscess, and to investigate contributing factors in successfully treated cases.
Retrospective, noncomparative, interventional case series.
Review of medical records of 22 consecutive patients with EKE and pyogenic liver abscess.
The affected eyes of 22 consecutive patients (n = 27) with EKE, who presented to our ophthalmic service during a recent 8-year period, were studied retrospectively.
Best-corrected visual acuity (VA) at end of follow up.
Diabetes mellitus was the most common comorbid risk factor (n = 15 [68%]). Five patients (23%) had bilateral eye involvement. On initial presentation, characteristic pupillary hypopyon was observed in 12 eyes. Diagnosis was confirmed by blood culture in 8 patients, culture of liver aspirate in 17 patients, and vitreous culture in 11 patients. Other associated septic metastatic lesions included pulmonary abscess or emboli in 6 cases, brain abscess or meningitis in 3 cases, and prostate and kidney abscesses in 1 case. Despite aggressive intravenous and intravitreal antibiotic therapy, final VA of light perception or worse affected 24 eyes (89%), of which 11 (41%) were eventually eviscerated or enucleated. Successful treatment with retained useful vision better than 6/60 was achieved in 3 eyes, of which 2 received early intravitreal corticosteroid injections. However, the other remaining eye had a focal subretinal abscess.
Physicians should be alert to the development of EKE when patients with diabetes along with K. pneumoniae-induced pyogenic liver abscess complain of ocular symptoms. In the majority of patients with EKE associated with pyogenic liver abscess, visual outcome is generally poor despite aggressive antibiotic therapy. Early diagnosis and prompt intervention with intravitreal antibiotics within 48 hours may salvage useful vision in some patients with EKE.
研究与肺炎克雷伯菌引起的化脓性肝脓肿相关的内源性肺炎克雷伯菌眼内炎（EKE）患者的危险因素、临床特征、治疗方法及视力预后，并探讨成功治疗病例的相关因素。
回顾性、非对照、干预性病例系列研究。
对22例连续性EKE合并化脓性肝脓肿患者的病历进行回顾。
回顾性研究最近8年期间在我院眼科就诊的22例连续性EKE患者（共27只患眼）。
随访结束时的最佳矫正视力（VA）。
糖尿病是最常见的合并危险因素（15例[68%]）。5例患者（23%）双眼受累。初诊时，12只眼中观察到特征性的瞳孔积脓。8例患者通过血培养确诊，17例患者通过肝穿刺抽吸物培养确诊，11例患者通过玻璃体培养确诊。其他相关的脓毒性转移性病变包括肺脓肿或栓子6例、脑脓肿或脑膜炎3例、前列腺和肾脓肿各1例。尽管积极进行静脉及玻璃体腔内抗生素治疗，但最终视力为光感或更差的患眼有24只（89%），其中11只（41%）最终行眼球内容剜除术或眼球摘除术。3只眼成功治疗后保留了优于6/60的有用视力，其中2只眼早期接受了玻璃体腔内皮质类固醇注射。然而，另一只保留视力的眼有局灶性视网膜下脓肿。
当糖尿病患者合并肺炎克雷伯菌引起的化脓性肝脓肿并出现眼部症状时，医生应警惕EKE的发生。在大多数合并化脓性肝脓肿的EKE患者中，尽管积极进行抗生素治疗，视力预后通常较差。早期诊断并在48小时内及时进行玻璃体腔内抗生素干预，可能挽救部分EKE患者的有用视力。
