Salvanet-Bouccara A, Cherifi M, Serrhini A, Feys J, Forestier F
Hôpital de Villeneuve-St-Georges, service d'Ophtalmologie.
J Fr Ophtalmol. 1990;13(6-7):333-8.
The authors report four cases of chronic endophthalmitis following extracapsular cataract extraction with intraocular lens implantation in the posterior chamber. The first attack of intraocular inflammation occurred in the form of recurrent iridocyclitis two to six months after surgery. The first attack usually responded well to local corticosteroids. After many relapses of inflammation, increasingly resistant to medical treatment, a severe attack occurred leading to the decision to treat such endophthalmitis surgically: endocular fluid aspiration, vitrectomy, intraocular injection of antibiotics combined with systemic antibiotics and corticosteroids. It may be very difficult to prove the infectious origin of torpid endophthalmitis. Growing bacteria from endocular fluid aspirates is much more difficult than in acute endophthalmitis. No organisms were found in this series by this method, despite the fact that fluid aspiration was often performed many times in these 4 cases. A bacterium was identified in 3 cases, twice on the implant itself and once after culture of an iridectomy specimen. Intraocular antibiotic injections resulted in the complete recovery of one patient. Following failure of standard treatment, intraocular lens explantation resulted in the disappearance of infectious inflammatory signs in 3 cases. The treatment of chronic endophthalmitis is governed by the same rules as acute endophthalmitis but is not always as successful. Intraocular lens removal is often the only solution and confirms the pathogenic hypothesis that slime production by organisms, their adherence to the intraocular lens and their quiescent state make them less vulnerable to antibiotics and host defences.
作者报告了4例白内障囊外摘除及后房型人工晶状体植入术后发生慢性眼内炎的病例。眼内炎症的首次发作表现为术后2至6个月反复发生的虹膜睫状体炎。首次发作通常对局部皮质类固醇治疗反应良好。在多次炎症复发且对药物治疗的耐药性日益增加后，发生了一次严重发作，从而决定对这种眼内炎进行手术治疗：眼内液抽吸、玻璃体切除术、眼内注射抗生素并联合全身应用抗生素和皮质类固醇。要证实慢性眼内炎的感染源可能非常困难。从眼内液抽吸物中培养出细菌比在急性眼内炎中要困难得多。在这一系列病例中，通过这种方法未发现任何微生物，尽管在这4例病例中经常多次进行眼内液抽吸。在3例病例中鉴定出一种细菌，两次是在人工晶状体本身，一次是在虹膜切除术标本培养后。眼内注射抗生素使1例患者完全康复。在标准治疗失败后，取出人工晶状体使3例病例中的感染性炎症体征消失。慢性眼内炎的治疗遵循与急性眼内炎相同的原则，但并非总是那么成功。取出人工晶状体往往是唯一的解决办法，这证实了一种致病假说，即微生物产生的黏液、它们对人工晶状体的黏附以及它们的静止状态使它们对抗生素和宿主防御的敏感性降低。
