Department of Opthlmology, B. P. Koirala Lions Center for Ophthalmic Studies BPKLCOS, Institute of Medicine, Nepal.
Ocul Immunol Inflamm. 2009 Nov-Dec;17(6):396-9. doi: 10.3109/09273940903216891.
To report 7 eyes of 7 patients who were diagnosed as the cases of endogenous endophthalmitis and proved by culture reports. Though in most of the previously published series, one or more predisposing factors were present in the patients of endogenous endophthalmitis, the authors are presenting a case series of culture-proven endogenous endophthalmitis in apparently healthy and immunocompetent individuals.
Retrospective noncomparative case series. All patients were diagnosed as endogenous bacterial endophthalmitis with positive vitreal culture. Variables studied were demographic characteristics, microbiology, therapeutic interventions done, final visual and anatomical outcome.
Streptococcus pneumoniae was the most frequent isolate 43% (3 out of 7 eyes) followed by Staphylococcus aureus and E. coli in equal frequency 29% (2 each out of 7 eyes). The median time between the onset of symptoms and presentation with features of endophthalmitis to hospital was 7 days. The presenting visual acuity was less than HM (hand motions) in all cases except one, which had VA of 20/200. No single underlying predisposing condition was identifiable in any of the cases. All the cases were given intravitreal therapeutic agents (one or more doses of antibiotics and steroid) and pars plana vitrectomy was performed in 2 cases. The final visual acuity was not better than presenting VA except in 1 case, which had final VA of 20/40. Intraocular pressure was on the lower side (mean IOP 7 mmHg compared to 12 mmHg in the fellow eye). No eye was enucleated or eviscerated.
Though in most of the previously published literature endogenous endophthalmitis has been a metastatic ocular infection, the present study describes a series of endogenous bacterial endophthalmitis de novo in onset, without any identifiable predisposing factors. The overall age of presentation was in a younger population than in previously published series. The overall visual outcome was poor, probably due to the serious nature of disease itself and the relatively late presentation.
报告 7 例经培养证实的内源性眼内炎患者的 7 只眼。尽管在大多数已发表的系列研究中，内源性眼内炎患者存在一种或多种潜在的诱发因素，但作者报告了一组无明显诱因且免疫功能正常的患者发生的经培养证实的内源性眼内炎病例系列。
回顾性非对照病例系列研究。所有患者均被诊断为内源性细菌性眼内炎，且玻璃体液培养阳性。研究的变量包括人口统计学特征、微生物学、治疗干预措施以及最终的视力和解剖学结果。
最常见的分离菌是肺炎链球菌，占 43%（7 只眼中的 3 只），其次是金黄色葡萄球菌和大肠杆菌，各占 29%（7 只眼中各 2 只）。从症状出现到出现眼内炎特征到医院就诊的中位时间为 7 天。所有病例的初始视力均低于 HM（手动视力），除 1 例外，该例视力为 20/200。在任何病例中都无法确定单一的潜在诱发因素。所有病例均给予玻璃体内治疗药物（一种或多种抗生素和类固醇），并在 2 例中进行了经睫状体平坦部玻璃体切除术。除 1 例外，最终视力均不如初始视力，该例最终视力为 20/40。眼内压较低（平均眼压 7mmHg，对侧眼眼压为 12mmHg）。没有眼球被摘除或眼内容剜除。
尽管在大多数已发表的文献中，内源性眼内炎是一种转移性眼部感染，但本研究描述了一组无明显诱因的初发内源性细菌性眼内炎。与已发表的系列研究相比，患者的总体发病年龄更年轻。总体视力预后较差，可能是由于疾病本身的严重程度以及相对较晚的就诊时间所致。
