Augenklinik, Universitätsklinikum Erlangen-Nürnberg, Erlangen, Deutschland.
Klin Monbl Augenheilkd. 2023 May;240(5):689-696. doi: 10.1055/a-1895-2720. Epub 2022 Jul 8.
Endophthalmitis is one of the most serious emergencies in ophthalmology. In order to reduce its prevalence, it is important to have a proper understanding of potential risk. Surgical therapy with targeted, pathogen-specific medication and an intact immune system are fundamental for preserving visual acuity. As it is unclear whether an unfavourable course is more likely in the presence of underlying ocular disease, a comparison was made between glaucoma patients (G) and non-glaucoma patients (NG) in terms of causative factors, pathogens, treatment and visual acuity. Since a potential alteration of the local immune system in glaucoma has been described, it is of interest to determine whether the clinical course of endophthalmitis in glaucoma patients differ from that of non-glaucoma patients.
A retrospective analysis of 75 eyes (13 G, 62 NG) who underwent treatment and surgery following a diagnosis of endophthalmitis in the Department of Ophthalmology, University of Erlangen-Nuremberg has been evaluated over a period of 5 years. Clinical characteristics, surgical treatment, microbial spectrum and visual acuity in glaucoma and non-glaucoma eyes were investigated.
Severe visual impairment (44%) with inflammation of the anterior chamber (62.7%), hypopyon (52%) and reduced (40%) or absent view (26.7%) of the fundus were predominantly present at first diagnosis in all patients. Previous eye surgery was observed in a total of 53%, primarily cataract surgery. Gram-positive cocci were seen as the most common causative agent in both groups, (G: 23.1%; NG: 38.7%), whereas other rare pathogens were present only in glaucomatous eyes. Pars plana vitrectomy was performed in 76% and enucleations in 20% of all patients, with the latter significantly more common in glaucomatous eyes (p = 0.01). A significant postoperative improvement in visual acuity was achieved in non-glaucoma patients (p < 0.001); visual acuity was worse in glaucomatous eyes.
Although rare, early diagnosis and treatment of endophthalmitis is crucial in terms of prognosis. In the present cohort, worse visual acuity outcomes were obtained in glaucoma patients in comparison to non-glaucoma patients.
眼内炎是眼科最严重的急症之一。为了降低其发病率，正确认识潜在风险非常重要。通过有针对性的、针对病原体的药物治疗和完整的免疫系统进行手术治疗，是保持视力的基础。由于目前尚不清楚是否存在基础眼病会使疾病进程恶化，因此对青光眼患者（G）和非青光眼患者（NG）的致病因素、病原体、治疗和视力进行了比较。由于已经描述了青光眼患者局部免疫系统可能发生改变，因此，确定青光眼患者眼内炎的临床病程是否与非青光眼患者不同，具有重要意义。
回顾性分析了在 5 年内于纽伦堡大学 Erlangen-Nuremberg 眼科就诊的 75 只眼（13 只 G，62 只 NG）的诊断和治疗情况。研究了青光眼和非青光眼眼中的临床特征、手术治疗、微生物谱和视力。
所有患者最初诊断时均存在严重视力损害（44%）、前房炎症（62.7%）、前房积脓（52%）、眼底可见度降低（40%）或消失（26.7%）。总共有 53%的患者存在眼部手术史，主要为白内障手术。两组中最常见的病原体均为革兰阳性球菌（G：23.1%；NG：38.7%），而其他罕见病原体仅见于青光眼眼。所有患者中 76%行玻璃体切除术，20%行眼球摘除术，后者在青光眼眼中更为常见（p=0.01）。非青光眼患者术后视力显著提高（p<0.001）；而青光眼患者的视力更差。
尽管罕见，但早期诊断和治疗眼内炎对预后至关重要。在本队列中，与非青光眼患者相比，青光眼患者的视力预后更差。
