Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
Ophthalmol Retina. 2020 Jun;4(6):560-567. doi: 10.1016/j.oret.2020.01.006. Epub 2020 Jan 13.
To assess how ocular ultrasound findings correlate with clinical parameters of patients with infectious keratitis and concern for endophthalmitis and to evaluate the usefulness of ultrasound in managing these patients.
Retrospective study.
Seventy-three eyes of 73 patients with microbial keratitis who underwent ultrasound to evaluate for endophthalmitis were included.
Ultrasound images were graded in a masked fashion independently by 2 retina specialists. The degree of vitreous opacities, defined as the largest area within the vitreous cavity occupied by opacities on any single image, were categorized as less than 10%, 10% to less than 50%, 50% to 90%, and more than 90%. The diagnosis of endophthalmitis was defined as severe intraocular inflammation that necessitated obtaining an intraocular culture sample and injection of intravitreal antimicrobials. The demographic and clinical characteristics of this patient cohort were compared.
Vitreous opacities measured quantitatively on ocular ultrasound.
The incidence of endophthalmitis in our patients with microbial keratitis who underwent ultrasound was 20.5%. Corneal and intraocular cultures showed positive results in 66.7% and 26.7% of endophthalmitis patients, respectively. A 4-fold increase in the likelihood of treatment for endophthalmitis was observed with increasing vitreous opacity severity (odds ratio, 3.97; confidence interval, 1.9-8.5; P < 0.0001). Endophthalmitis was associated with 50% or more vitreous opacities (P < 0.001), older age (P < 0.001), pseudophakia (P = 0.001), and hypopyon height (P < 0.001). Eye pain, eyelid edema, poor presenting visual acuity, larger corneal ulcer diameter, and causative organisms were not associated with endophthalmitis.
Patients with more severe vitreous opacities on ultrasound were more likely to be treated for endophthalmitis. Patients with microbial keratitis, who were older and pseudophakic, were prone to have more severe vitreous opacities.
评估眼超声检查结果与感染性角膜炎患者的临床参数的相关性，并探讨超声在这些患者诊治中的作用。
回顾性研究。
纳入 73 例微生物性角膜炎患者 73 只眼，这些患者均行超声检查以评估眼内炎的发生。
两名视网膜专家对超声图像进行了盲法独立分级。玻璃体混浊程度是指在任何单个图像中，玻璃体腔中被混浊物占据的最大面积，分为小于 10%、10%至小于 50%、50%至 90%和大于 90%。眼内炎的诊断定义为需要进行眼内培养样本采集和玻璃体内注射抗菌药物的严重眼内炎症。比较了该患者队列的人口统计学和临床特征。
眼超声检查定量测量的玻璃体混浊程度。
在接受超声检查的微生物性角膜炎患者中，眼内炎的发生率为 20.5%。角膜和眼内培养结果显示，眼内炎患者的阳性率分别为 66.7%和 26.7%。玻璃体混浊程度越严重，眼内炎治疗的可能性增加 4 倍（比值比，3.97；95%置信区间，1.9~8.5；P<0.0001）。眼内炎与 50%或更多的玻璃体混浊（P<0.001）、年龄较大（P<0.001）、人工晶状体眼（P=0.001）和前房积脓高度（P<0.001）有关。眼部疼痛、眼睑肿胀、初始视力较差、更大的角膜溃疡直径和致病微生物与眼内炎无关。
超声检查显示玻璃体混浊越严重的患者，越有可能接受眼内炎治疗。年龄较大和人工晶状体眼的微生物性角膜炎患者更容易出现严重的玻璃体混浊。
