Department of Ophthalmology, Wroclaw Medical University, Wroclaw, Poland.
Med Sci Monit. 2010 Jun;16(6):CR296-300.
To determine the therapeutic and diagnostic value of vitreoretinal surgery in various types of severe viral retinitis and endogenous endophthalmitis.
MATERIAL/METHODS: Pars plana vitrectomy with silicon-oil tamponade was performed on 12 eyes (12 patients) with severe viral retinitis and endogenous endophthalmitis. The mean age of the patients was 35.2 years (range, 18-56 years). Investigations consisted of chest radiography, RT 23, serology (for toxoplasmosis, cytomegalovirus, herpes simplex virus, and human immunodeficiency virus), and routine blood tests and urinalysis. Examination of vitreous samples consisted of polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Mycobacterium tuberculosis, and cultures for fungi and bacteria. The results were analyzed 7 days and 6 months after surgery.
Analysis of vitreous samples showed cytomegalovirus in 3 patients, herpes simplex virus in 2, tuberculosis in 2, and Candida albicans in 5. All patients had improvement in visual acuity and severity of clinical signs seven days after surgery and in 10 cases after long-term follow-up. Final visual acuity was compromised by chronic macular edema, postinflammatory macular scarring, optic atrophy, subcapsular cataract formation, and capsular opacification after cataract surgery.
Modern laboratory tests are useful for quick and accurate diagnosis of atypical cases of severe infectious posterior uveitis. Early pars plana vitrectomy with silicon oil tamponade is valuable in diagnosing and treating severe infectious posterior uveitis and endophthalmitis.
确定玻璃体视网膜手术在各种严重病毒性视网膜炎和内源性眼内炎中的治疗和诊断价值。
材料/方法：对 12 例（12 例患者）严重病毒性视网膜炎和内源性眼内炎患者行睫状体平坦部玻璃体切除术联合硅油填充。患者平均年龄 35.2 岁（18-56 岁）。检查包括胸部 X 线、RT 23、血清学检查（用于检测弓形虫病、巨细胞病毒、单纯疱疹病毒和人类免疫缺陷病毒）、常规血液检查和尿液分析。玻璃体样本检查包括巨细胞病毒、单纯疱疹病毒和结核分枝杆菌的聚合酶链反应，以及真菌和细菌培养。术后 7 天和 6 个月进行分析。
对玻璃体样本的分析显示 3 例患者存在巨细胞病毒，2 例患者存在单纯疱疹病毒，2 例患者存在结核分枝杆菌，5 例患者存在白色念珠菌。所有患者术后 7 天视力和临床体征严重程度均有改善，10 例患者长期随访后视力改善。慢性黄斑水肿、炎症后黄斑瘢痕、视神经萎缩、后发性白内障和白内障手术后囊膜混浊导致最终视力受损。
现代实验室检查对于快速准确诊断不典型严重感染性后葡萄膜炎非常有用。早期行睫状体平坦部玻璃体切除术联合硅油填充对视神经炎和眼内炎的诊断和治疗有价值。
