Liu Meng-Yang, Zhang Li, Yin Xiao-Lin, Sun Shi-Ying
Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, P.R. China.
Department of Basic Medical Sciences, Qingdao University, Qingdao, P.R. China.
Eur J Ophthalmol. 2020 May;30(3):455-461. doi: 10.1177/1120672119833896. Epub 2019 Mar 4.
To report the laboratory findings, management strategies, and visual outcomes of culture-proven exogenous fungal endophthalmitis in North China.
The microbiological and treatment records of patients with culture-positive exogenous fungal endophthalmitis who visited the Affiliated Hospital of Qingdao University from January 2012 to December 2016 were reviewed.
A total of 39 eyes (39 patients) were identified over a 5-year period. Exogenous fungal endophthalmitis was associated with penetrating trauma in 22 eyes (56.4%), fungal keratitis in 15 eyes (38.5%), and intraocular surgery in 2 eyes (5.1%). Hyphae were found in 29 of 37 smear samples (78.4%) by direct microscopic examination. Fungal pathogens cultured from 39 samples were identified as 10 genera and 15 species. Filamentous fungi (molds) accounted for 94.9% (37 samples), including (19, 48.7%) and (11, 28.2%). Most keratitis cases were caused by (11 of 15; 73.3 %). was isolated from nine penetrating ocular trauma cases (9 of 22; 40.9%). Three eyes receiving evisceration had fungal and bacteria coinfection (3 of 39, 7.7%) with and . At least, one surgical intervention was performed in all 39 eyes and 28 (71.8%) eyes underwent two or more procedures, including surgeries and intraocular injections. Twenty-nine patients received intraocular antifungal therapy with amphotericin B and/or voriconazole. Visual acuity at discharge from the hospital was significantly better than the initial visual acuity ( < 0.001). Final vision of 20/400 or better was achieved in 22 (56.4%) eyes.
This study highlighted the differences between clinical categories of exogenous fungal endophthalmitis. Trauma was the major etiological factor. Molds were the most common pathogens, with ranking first, followed by Fungal and bacterial coinfection mostly occurred after metal penetrating trauma, and was the primary bacterial pathogen. Coinfection may be one reason of evisceration. Immediate intravitreal antifungal therapy combined with vitrectomy was effective for exogenous fungal endophthalmitis. Amphotericin B and voriconazole were commonly used antifungal agents.
报告中国北方经培养证实的外源性真菌性眼内炎的实验室检查结果、治疗策略及视力预后。
回顾2012年1月至2016年12月期间就诊于青岛大学附属医院的培养阳性的外源性真菌性眼内炎患者的微生物学及治疗记录。
在5年期间共确诊39眼（39例患者）。外源性真菌性眼内炎与22眼（56.4%）的穿透性外伤、15眼（38.5%）的真菌性角膜炎及2眼（5.1%）的眼内手术有关。通过直接显微镜检查，在37份涂片样本中的29份（78.4%）发现了菌丝。从39份样本中培养出的真菌病原体被鉴定为10个属和15个种。丝状真菌（霉菌）占94.9%（37份样本），包括曲霉菌（19份，48.7%）和镰刀菌（11份，28.2%）。大多数角膜炎病例由曲霉菌引起（15例中的11例；73.3%）。镰刀菌从9例穿透性眼外伤病例中分离得到（22例中的9例；40.9%））。3例行眼球摘除术的患眼中有真菌和细菌混合感染（39例中的3例，7.7%），病原体为曲霉菌和金黄色葡萄球菌。所有39眼均至少进行了一次手术干预，28眼（71.8%）接受了两次或更多次手术，包括手术和眼内注射。29例患者接受了两性霉素B和/或伏立康唑的眼内抗真菌治疗。出院时的视力明显优于初始视力（P<0.001）。22眼（56.4%）最终视力达到20/400或更好。
本研究强调了外源性真菌性眼内炎临床类型之间的差异。外伤是主要病因。霉菌是最常见的病原体，曲霉菌居首位，其次是镰刀菌。真菌和细菌混合感染大多发生在金属穿透性外伤后，金黄色葡萄球菌是主要的细菌病原体。混合感染可能是眼球摘除术的原因之一。立即进行玻璃体腔内抗真菌治疗联合玻璃体切除术对外源性真菌性眼内炎有效。两性霉素B和伏立康唑是常用的抗真菌药物。
