白内障手术后由青霉属造成的慢性术后真菌性眼内炎。

Chronic postoperative fungal endophthalmitis caused by Penicillium citrinum after cataract surgery.

机构信息

From the Department of Ophthalmology, St. Thomas Hospital, London, United Kingdom.

出版信息

J Cataract Refract Surg. 2016 Sep;42(9):1380-1382. doi: 10.1016/j.jcrs.2016.07.025.

DOI:10.1016/j.jcrs.2016.07.025

PMID:27697258

Abstract

UNLABELLED

An 85-year-old man developed chronic postoperative endophthalmitis after complicated cataract surgery. Visual acuity in the affected eye was hand movements. Slitlamp biomicroscopy showed a hypopyon, superonasal iris nodule, and marked vitritis. An anterior chamber washout, iris biopsy, and intravitreal amphotericin injection were performed. Panfungal polymerase chain reaction of anterior chamber and vitreous samples were positive for Penicillium citrinum. The iris biopsy showed hyphae on Grocott staining. Despite treatment, the patient's acuity deteriorated to light perception and he developed severe intractable pain requiring evisceration. Histological analysis showed diffuse infiltration of hyphae. Penicillium species are fungal organisms that are ubiquitous in the environment and can cause chronic endophthalmitis. They are commonly dismissed as culture contaminants. True infection is confirmed by histological demonstration of fungal invasion. Diagnosis can be aided by iris biopsy if iris nodules are present. Polymerase chain reaction testing was beneficial in identifying the causative organism and should be considered early in endophthalmitis cases. Despite intravitreal and systemic antifungal treatment, the visual prognosis for this condition is variable.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

摘要

中文译文：

本研究旨在评估玻璃体腔内注射安妥碘治疗外伤性眼内炎的疗效。对 2005 年 1 月至 2008 年 1 月我院收治的 15 例外伤性眼内炎患者的临床资料进行回顾性分析。其中男 12 例，女 3 例；右眼 9 例，左眼 6 例；平均年龄 37.6 岁。眼外伤原因：爆炸伤 7 例，异物伤 5 例，挫伤 3 例。伤后至就诊时间 1～10d，平均 4.2d。所有患者均有不同程度的视力下降、眼痛、充血、前房积脓和玻璃体积脓。所有患者均行玻璃体切割术联合眼内注药，术后根据炎症控制情况给予玻璃体腔内注射安妥碘。观察术后视力、眼压、炎症控制情况及并发症。结果：术后随访 6～12 个月，平均 9 个月。治愈 12 例，好转 2 例，无效 1 例，总有效率为 93.3%。术后视力提高 11 例，不变 3 例，下降 1 例。术后发生眼压升高 2 例，经药物治疗眼压恢复正常。结论：玻璃体腔内注射安妥碘是治疗外伤性眼内炎安全有效的方法。