Bhala S, Narang S, Sood S, Mithal C, Arya S K, Gupta V
Department of Ophthalmology and Microbiology, Government Medical College Hospital, Chandigarh, India.
Nepal J Ophthalmol. 2012 Jan-Jun;4(1):84-9. doi: 10.3126/nepjoph.v4i1.5857.
Endophthalmitis is the most dreaded complication of ocular trauma and knowledge of the microbial contaminants is essential to start empirical antibiotic therapy.
To determine incidence of contamination after open globe injuries (OGI) in our setup and to identify the spectrum of microorganisms contaminating open globe injuries.
A prospective study including 50 consecutive eyes of open globe injury over a period of two years was conducted. Intra-operatively, 4 - 5 samples were taken from the inferior conjunctival sac and anterior chamber at the beginning and end of the open globe injury repair. Any abscised tissue or foreign body was also sent for culture sensitivity. A vitreous tap was taken from eyes with posterior segment trauma with signs of endophthalmitis.
Microbial cultures were positive in13 eyes (26 %). The microbial spectrum included Aspergillus species in 45.6 %, Alternaria in 15.2 %, Curvularia in 15.2 %, Staphylococcus aureus in 7.6 %, Bacillus species in 7.6 %, and Streptococcus pneumoniae in 7.6 %. Of these 13 eyes, nine eyes developed clinically evident frank endophthalmitis during follow-up. Overall, endophthalmitis developed in 20 eyes (40 %). There was a significant association between the initial contamination and development of endophthalmitis (p less than 0.05). 53 % of culture positive cases achieved ambulatory vision compared to 73 % of culture-negative cases.
Initial contamination was seen in 26 % of OGI cases. Aspergillus (fungus) was the commonest contaminant. There was a strong correlation between the initial contamination and development of endophthalmitis. Culture-negative cases had a trend towards better final visual outcome than culture-positive cases. Close follow up of cases showing contamination following OGI is recommended.
眼内炎是眼外伤最可怕的并发症，了解微生物污染物对于开始经验性抗生素治疗至关重要。
确定我们机构中开放性眼球损伤（OGI）后污染的发生率，并确定污染开放性眼球损伤的微生物谱。
进行了一项前瞻性研究，在两年期间纳入了50例连续的开放性眼球损伤患者的眼睛。术中，在开放性眼球损伤修复开始和结束时，从下结膜囊和前房采集4 - 5份样本。任何切除的组织或异物也送去做培养药敏试验。对有眼内炎迹象的后段外伤眼进行玻璃体穿刺。
微生物培养在13只眼中呈阳性（26%）。微生物谱包括曲霉菌属占45.6%，链格孢属占15.2%，弯孢属占15.2%，金黄色葡萄球菌占7.6%，芽孢杆菌属占7.6%，肺炎链球菌占7.6%。在这13只眼中，9只眼在随访期间发展为临床明显的急性眼内炎。总体而言，20只眼（40%）发生了眼内炎。初始污染与眼内炎的发生之间存在显著关联（p小于0.05）。培养阳性病例中53%实现了门诊视力，而培养阴性病例中这一比例为73%。
26%的OGI病例存在初始污染。曲霉菌（真菌）是最常见的污染物。初始污染与眼内炎的发生之间存在很强的相关性。培养阴性病例的最终视觉结果比培养阳性病例有更好的趋势。建议对OGI后显示污染的病例进行密切随访。
