Chen Kuan-Jen, Chen Yen-Po, Chao An-Ning, Wang Nan-Kai, Wu Wei-Chi, Lai Chi-Chun, Chen Tun-Lu
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tayouan, Taiwan.
PLoS One. 2017 Jan 5;12(1):e0169603. doi: 10.1371/journal.pone.0169603. eCollection 2017.
Panophthalmitis is the most extensive ocular involvement in endophthalmitis with inflammation in periocular tissues. Severe inflammation of the anterior and posterior segments is frequently accompanied by corneal opacity, scleral abscess, and perforation or rupture. Enucleation or evisceration was the only remaining viable treatment option when all options to salvage the eye had been exhausted. The purpose of this retrospective study is to examine the outcomes of patients with endogenous bacterial panophthalmitis, no light perception and scleral abscess who were treated with multiple intravitreal and periocular injections of antibiotics and dexamethasone. Evaluation included spreading of infection to contiguous or remote sites, following evisceration or enucleation, and sympathetic ophthalmia. Eighteen patients were diagnosed with EBP, with liver abscesses in eight patients, retroperitoneal infection in four, pneumonia in two, infective endocarditis in one, cellulitis in one, drug abuse in one, and mycotic pseudoaneurysm in one. Culture results were positive for Klebsiella pneumoniae in 12 patients, Streptococcus spp. in three, Pseudomonas aeruginosa in one, Escherichia coli in one, and Staphylococcus aureus in one. The average number of periocular injections was 2.2, and the average number of intravitreal injections was 5.8. No eye required evisceration or enucleation and developed the spreading of infection to contiguous or remote sites during the follow-up. No sympathetic ophthalmia was observed in the fellow eye of all patients. Prevention of evisceration or enucleation in patients with EBP, NLP and scleral abscess can be achieved by multiple intravitreal and periocular injections of antibiotics and dexamethasone.
全眼球炎是眼内炎中最广泛的眼部受累情况，伴有眼周组织炎症。眼前段和后段的严重炎症常伴有角膜混浊、巩膜脓肿以及穿孔或破裂。当所有挽救眼球的方法都用尽时，眼球摘除术或眼内容剜出术是唯一可行的治疗选择。这项回顾性研究的目的是检查患有内源性细菌性全眼球炎、无光感且有巩膜脓肿的患者，接受多次玻璃体内和眼周注射抗生素及地塞米松后的治疗结果。评估内容包括感染扩散至相邻或远处部位、眼球摘除术或眼内容剜出术后情况以及交感性眼炎。18例患者被诊断为内源性细菌性全眼球炎，其中8例有肝脓肿，4例有腹膜后感染，2例有肺炎，1例有感染性心内膜炎，1例有蜂窝织炎，1例有药物滥用，1例有霉菌性假性动脉瘤。12例患者的培养结果显示肺炎克雷伯菌阳性，3例为链球菌属，1例为铜绿假单胞菌，1例为大肠杆菌，1例为金黄色葡萄球菌。眼周注射的平均次数为2.2次，玻璃体内注射的平均次数为5.8次。在随访期间，没有眼球需要进行眼球摘除术或眼内容剜出术，也没有出现感染扩散至相邻或远处部位的情况。所有患者的对侧眼均未观察到交感性眼炎。对于患有内源性细菌性全眼球炎、无光感且有巩膜脓肿的患者，通过多次玻璃体内和眼周注射抗生素及地塞米松可避免进行眼球摘除术或眼内容剜出术。
