Tóth Gábor, Pluzsik Milán Tamás, Sándor Gábor László, Németh Orsolya, Lukáts Olga, Nagy Zoltán Zsolt, Szentmáry Nóra
Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
Department of Ophthalmology, Bajcsy-Zsilinszky Hospital, Budapest, Hungary.
J Ophthalmol. 2020 May 18;2020:8283131. doi: 10.1155/2020/8283131. eCollection 2020.
To analyse the clinical and microbiological characteristics and preexisting ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 12 years. . A retrospective review of enucleated/eviscerated eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary indication for enucleation or evisceration. For each subject, clinical history, B-scan ultrasound report, and microbiological analyses were reviewed.
There were 48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time of surgery 66.4 ± 18.5 years). Indication for surgery was hopeless, unmanageable keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%), and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%) tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment of enucleation or evisceration. The most frequent preexisting systemic diseases were hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid arthritis (14.6%). (17.0%) and (12.8%) were the most commonly isolated gram-positive bacteria, and was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes (12.5%) had positive fungal cultures (1 case of , , , sp., sp., and sp.).
, and keratitis with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration in patients with microbial keratitis in a tertiary referral center in Hungary. The incidence of enucleation and evisceration related to mycotic keratitis does not seem to have increased within the last decade. Most frequent preexisting systemic diseases in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes mellitus, and rheumatoid arthritis.
分析在一个发达国家（匈牙利）的大型三级转诊中心，12年间导致眼球摘除/眼内容剜出术的感染性角膜炎的临床和微生物学特征以及既往眼部和全身疾病情况。回顾性分析2007年至2018年在匈牙利布达佩斯塞梅尔维什大学眼科接受手术的因感染性角膜炎作为眼球摘除或眼内容剜出术主要指征的摘除/剜出眼球病例。对每个患者的临床病史、B超报告和微生物学分析进行回顾。
47例患者共48只摘除/剜出眼球（29例女性（61.7%），手术时年龄66.4±18.5岁）。手术指征为无可挽救、难以控制的角膜炎（62.5%）以及伴有眼内炎的角膜炎（37.5%）。最常见的既往眼部疾病是既往白内障手术（60.4%）、既往治疗性穿透性角膜移植术（PKP）（56.3%）、角膜穿孔（52.1%）、青光眼（41.7%）以及长期局部使用类固醇（31.3%）。为治疗角膜炎，在眼球摘除或眼内容剜出术前，20只眼（41.7%）接受了PKP，12只眼（25.0%）接受了羊膜移植，8只眼（16.7%）接受了自体结膜移植，6只眼（12.5%）接受了睑裂缝合术，4只眼（8.3%）接受了玻璃体切除术以挽救眼球，然后才进行最终的眼球摘除或眼内容剜出术。最常见的既往全身疾病是高血压（62.5%）、心脏病（20.8%）、糖尿病（20.8%）和类风湿关节炎（14.6%）。（17.0%）和（12.8%）是最常分离出的革兰氏阳性菌，是最常分离出的革兰氏阴性病原菌（10.6%）。6个眼球（12.5%）真菌培养呈阳性（1例为、、、种、种和种）。
伴或不伴眼内炎的、和角膜炎是匈牙利三级转诊中心微生物性角膜炎患者眼球摘除/眼内容剜出术最常见的指征。在过去十年中，与真菌性角膜炎相关的眼球摘除和眼内容剜出术的发生率似乎没有增加。眼球摘除和眼内容剜出术病例中最常见的既往全身疾病是高血压、心脏病、糖尿病和类风湿关节炎。
