Piest K L, Kincaid M C, Tetz M R, Apple D J, Roberts W A, Price F W
Department of Ophthalmology, University of Utah Health Sciences Center, Salt Lake City 84132.
J Cataract Refract Surg. 1987 Sep;13(5):498-510. doi: 10.1016/s0886-3350(87)80103-7.
We report five cases of post-extracapsular cataract extraction infection in which subsequent pathologic analyses identified the organisms and found the infection to be localized or confined to the lens capsular sac. The most common offending organisms were gram-positive pleomorphic bacilli. In one case, we were able to identify the bacteria as Propionibacterium acnes. We designate this condition a localized endophthalmitis. It should be considered any time a persistent, smoldering, postoperative inflammation occurs, and in the differential diagnosis of phacoanaphylactic endophthalmitis. The condition itself is not new, but undoubtedly many such cases have gone unrecognized or have been misdiagnosed as the so-called toxic lens syndrome. In localized endophthalmitis, a clinically visible inflammatory process may occur even when multiple diagnostic taps are negative, although when the cases first appeared, the surgeons were not aware of the entity and anaerobic cultures were not always obtained. A negative tap may be explained by the fact that metabolic products from the organisms are released from the bag into the anterior segment and vitreous. A synergistic reaction may occur between these organisms and retained lens cortical remnants that may cause or exacerbate a hypersensitivity reaction. The condition may be worsened by Nd:YAG capsulotomy. The pathogenesis of localized endophthalmitis has nothing to do with the type of intraocular lens fixation (lens capsular sac or ciliary sulcus); rather, the simple presence of a capsular sac after extracapsular cataract extraction is the prerequisite for the clinical condition.
我们报告了5例囊外白内障摘除术后感染病例，后续的病理分析确定了病原体，并发现感染局限于晶状体囊袋内。最常见的致病微生物是革兰氏阳性多形性杆菌。在1例病例中，我们能够鉴定出细菌为痤疮丙酸杆菌。我们将这种情况命名为局限性眼内炎。每当出现持续性、隐匿性术后炎症时均应考虑该病，并在晶状体过敏性眼内炎的鉴别诊断中加以考虑。这种情况本身并非新现象，但毫无疑问，许多此类病例未被识别或被误诊为所谓的毒性晶状体综合征。在局限性眼内炎中，即使多次诊断性穿刺结果为阴性，临床上仍可能出现可见的炎症过程，尽管在这些病例初发时，外科医生并不知晓这种疾病实体，也并非总是进行厌氧菌培养。穿刺结果为阴性可能是因为病原体的代谢产物从囊袋释放到前房和玻璃体中。这些微生物与残留的晶状体皮质之间可能发生协同反应，这可能会引发或加剧超敏反应。钕：钇铝石榴石激光晶状体囊切开术可能会使病情恶化。局限性眼内炎的发病机制与人工晶状体固定方式（晶状体囊袋或睫状沟）无关；相反，囊外白内障摘除术后存在囊袋是这种临床情况的先决条件。
