Bialasiewicz A A, Wilk C M, Ruprecht K W
Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Klin Monbl Augenheilkd. 1991 Mar;198(3):190-4. doi: 10.1055/s-2008-1045950.
Advances of therapeutic strategies in the management of critically ill patients have resulted in an increased life expectancy and more frequent presentations to ophthalmic surgeons. Six patients with postoperative endophthalmitis after elective intraocular surgery suffering from Sharp-syndrome, metastasizing antrum carcinoma, granulomatous vasculitis and immunosuppressive therapy, agranulocytosis, silico-tuberculosis and chronic lymphatic leukemia revealed traditionally pathogenic agents (Proteus mirabilis, P. aeruginosa, enterococci, coagulase-negative Staph). Two patients had to be enucleated, one turned blind and three had a visual acuity 5/100 to 20/60. In our hands prognosis for successful therapy in immunodeficient patients seems worse than in otherwise healthy persons. Painstaking evaluation of history, medical work-up, conjunctival swabs and application of bactericidal topical antibiotics preoperatively and perioperatively are particularly important in these patients.
危重症患者治疗策略的进展使得预期寿命延长,眼科外科医生接诊此类患者的频率也更高。6例择期眼内手术后发生眼内炎的患者,分别患有夏普综合征、转移性鼻窦癌、肉芽肿性血管炎并接受免疫抑制治疗、粒细胞缺乏症、硅肺结核和慢性淋巴细胞白血病,均发现了传统病原体(奇异变形杆菌、铜绿假单胞菌、肠球菌、凝固酶阴性葡萄球菌)。2例患者不得不摘除眼球,1例失明,3例视力为5/100至20/60。在我们看来,免疫缺陷患者成功治疗的预后似乎比健康人更差。对于这些患者,术前和围手术期仔细评估病史、进行医学检查、采集结膜拭子并应用杀菌局部抗生素尤为重要。