Liu Fang, Kwok Alvin K H, Cheung Bernard M Y
Department of Retina and Vitreous, Suzhou Eye Hospital, Wenzhou Medical College, P. R. China.
Curr Eye Res. 2008 Sep;33(9):761-8. doi: 10.1080/02713680802344690.
Bacillus cereus causes the most virulent and refractory form of endophthalmitis. The authors analyzed effectiveness of intravitreal vancomycin with or without dexamethasone for experimental Bacillus cereus endophthalmitis.
Rabbit eyes were injected intravitreally with 1x10(6) colony-forming units of Bacillus cereus organisms. At 24 hours after injection, eyes were injected intravitreally with 0.1 ml of balanced salt solution (group 1, n=10), 1 mg vancomycin (group 2, n=10), and antibiotic plus 0.4 mg dexamethasone (group 3, n=10). Inflammatory scores were assessed 7 days and 14 days after treatment. Furthermore, histologic grading was carried out at the conclusion of the clinical observations.
Eyes treated with vancomycin, with or without dexamethasone at 7 days and 14 days expressed significant less inflammation over iris and vitreous than the control group (p<0.05). Moreover, eyes treated with vancomycin with dexamethasone showed less inflammation over the conjunctiva and vitreous at 7 days and over the iris and vitreous at 14 days, compared to antibiotic treatment alone (p<0.05). Additionally, at 14 days, the histopathological changes of eyes treated with vancomycin with dexamethasone had less conjunctival inflammation, mild iridocyclitis, less vitreous cells, and less choroidal vasculitis and retinitis compared to control group and antibiotic treatment alone, respectively (p<0.05).
Intravitreal injection of vancomycin improved the therapeutic outcome of Bacillus cereus endophthalmitis. The addition of dexamethasone to antibiotic treatment provided a therapeutic benefit over antibiotic alone.
蜡样芽孢杆菌可引发最具毒性且难治的眼内炎形式。作者分析了玻璃体内注射万古霉素联合或不联合地塞米松治疗实验性蜡样芽孢杆菌眼内炎的有效性。
向兔眼玻璃体内注射1×10⁶个蜡样芽孢杆菌菌落形成单位。注射后24小时，向眼内玻璃体内注射0.1 ml平衡盐溶液（第1组，n = 10）、1 mg万古霉素（第2组，n = 10）以及抗生素加0.4 mg地塞米松（第3组，n = 10）。在治疗后7天和14天评估炎症评分。此外，在临床观察结束时进行组织学分级。
在7天和14天时，接受万古霉素治疗的眼，无论是否联合地塞米松，其虹膜和玻璃体的炎症均显著低于对照组（p < 0.05）。此外，与单独使用抗生素治疗相比，在7天时，联合地塞米松的万古霉素治疗组眼结膜和玻璃体的炎症较轻；在14天时，虹膜和玻璃体的炎症较轻（p < 0.05）。另外，在14天时，与对照组和单独使用抗生素治疗相比，联合地塞米松的万古霉素治疗组眼的组织病理学变化表现为结膜炎症较轻、虹膜睫状体炎较轻、玻璃体细胞较少、脉络膜血管炎和视网膜炎较少（p < 0.05）。
玻璃体内注射万古霉素可改善蜡样芽孢杆菌眼内炎的治疗效果。在抗生素治疗中添加地塞米松比单独使用抗生素具有更好的治疗效果。
