Hemady R, Zaltas M, Paton B, Foster C S, Baker A S
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Br J Ophthalmol. 1990 Jan;74(1):26-9. doi: 10.1136/bjo.74.1.26.
We reviewed the charts of 10 patients who were admitted to the Massachusetts Eye and Ear Infirmary over a 10-year period with the diagnosis of Bacillus species endophthalmitis. To our knowledge this is the largest single series in the literature and includes the first two reported cases of Bacillus endophthalmitis following glaucoma filtering procedures. Seven cases developed following penetrating ocular trauma. One occurred in an intravenous drug abuser. Five eyes ultimately underwent enucleation; only the two eyes that developed endophthalmitis after elective surgery retained useful vision. Review of the literature indicates that parenteral and intravitreal antibiotic prophylaxis against endophthalmitis after penetrating ocular trauma should include gentamicin, in combination with vancomycin or clindamycin, to provide adequate coverage against infection with Bacillus spp., as prognosis is poor once infection is established. Bacillus spp. cultured from ocular tissues or fluids should not be dismissed as contaminants.
我们回顾了10年间收治于马萨诸塞州眼耳医院、诊断为芽孢杆菌性眼内炎的10例患者的病历。据我们所知，这是文献中最大的单一系列病例，且包括青光眼滤过术后报告的首例和第二例芽孢杆菌性眼内炎病例。7例在穿透性眼外伤后发生。1例发生于静脉注射毒品者。5只眼最终接受了眼球摘除术；仅2只在择期手术后发生眼内炎的眼睛保留了有用视力。文献回顾表明，穿透性眼外伤后预防眼内炎的全身及玻璃体内抗生素应包括庆大霉素，并联合万古霉素或克林霉素，以提供针对芽孢杆菌属感染的充分覆盖，因为一旦感染确立，预后很差。从眼组织或眼液中培养出的芽孢杆菌属不应被视为污染物而不予理会。
