Durand Marlene L
Departments of Medicine and Ophthalmology, Harvard Medical School, and Infectious Disease Service, Massachusetts Eye and Ear Infirmary, and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Clin Microbiol Rev. 2017 Jul;30(3):597-613. doi: 10.1128/CMR.00113-16.
Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.
眼内炎是一种严重的眼部感染，可能导致患眼永久性丧失有用视力。大多数病例为外源性，发生于白内障手术、玻璃体内注射或穿透性眼外伤的并发症。内源性眼内炎是由细菌或真菌经血行播散至眼内所致，但菌血症或真菌血症可能是短暂的，患者可能无全身感染症状。几乎所有眼内炎患者都有视力下降，部分患者还伴有眼痛。眼部检查通常可见前房积脓和眼内炎症。诊断依靠临床症状，玻璃体液和/或房水培养或某些内源性病例的血培养可提供支持。分子诊断技术已在研究实验室用于眼内炎病原体鉴定，并提供了快速诊断的可能性，包括在培养阴性的病例中。玻璃体内注射抗生素是治疗的最重要组成部分；一些病例还受益于通过玻璃体切除术进行的玻璃体手术清创。视力预后部分取决于病原体：例如，凝固酶阴性葡萄球菌性眼内炎的预后比链球菌性眼内炎要好。眼内炎是一种医疗急症，及时诊断和治疗对于挽救视力至关重要。
