Budoff Greg, Zarbin Marco A, Bhagat Neelakshi
Institute of Ophthalmology and Visual Science, Rutgers-New Jersey Medical School, Newark, NJ, USA.
Stein Eye Institute, University of California, Los Angeles, CA, USA.
J Vitreoretin Dis. 2020 Sep 17;5(2):135-141. doi: 10.1177/2474126420951979. eCollection 2021 Mar-Apr.
This work describes the characteristics, treatment, and outcomes of endogenous endophthalmitis (EE) cases over 13 years at a tertiary care hospital.
This retrospective case series included EE cases from 2006 to 2018. Eyes were categorized by cultured organism and initial treatment status.
Forty-five eyes of 38 patients were identified with EE. Mean age was 48 ± 12 years and approximately three-fourths were male. Mean visual acuity (VA) at presentation was logMAR 1.86 ± 0.83. More than 50% of patients had a history of intravenous drug use. In a quarter of patients, no systemic source of infection was identified; 90% of these patients had a history of intravenous drug use. Bilateral infections occurred in 18% of participants. Of positive cultures, 29%, 56%, and 13% were fungal, gram-positive, and gram-negative in etiology, respectively. Eyes with fungal infections had a better presenting VA and were more likely to have better than 20/100 final VA vs those with bacterial infections. All patients received IV antibiotics; additionally 29% of eyes underwent initial combined pars plana vitrectomy with intravitreal antibiotic injection while 51% of eyes initially received bedside intravitreal antibiotic injection. There was no significant difference in final VA with respect to initial mode of treatment.
Initial treatment of intravitreal antibiotics with or without pars plana vitrectomy did not show any difference in the average final VA in eyes with EE. Eyes with fungal infections had more favorable visual outcomes than those with bacterial infections. Almost 1 in 5 EE eyes were enucleated.
本研究描述了一家三级医疗医院13年间内源性眼内炎（EE）病例的特征、治疗方法及治疗结果。
本回顾性病例系列研究纳入了2006年至2018年的EE病例。根据培养出的病原体及初始治疗情况对患眼进行分类。
共确定38例患者的45只眼患有EE。平均年龄为48±12岁，约四分之三为男性。就诊时的平均视力（VA）为logMAR 1.86±0.83。超过50%的患者有静脉吸毒史。四分之一的患者未发现全身性感染源；这些患者中有90%有静脉吸毒史。18%的参与者发生了双侧感染。在阳性培养结果中，病因分别为真菌、革兰氏阳性菌和革兰氏阴性菌的占29%、56%和13%。与细菌感染的患眼相比，真菌感染的患眼就诊时视力较好，最终视力优于20/100的可能性更大。所有患者均接受静脉注射抗生素治疗；此外，29%的患眼最初接受了玻璃体切割联合玻璃体内抗生素注射，而51%的患眼最初接受了床边玻璃体内抗生素注射。最终视力在初始治疗方式方面无显著差异。
对于EE患眼，初始采用玻璃体内抗生素治疗，无论是否联合玻璃体切割术，平均最终视力均无差异。真菌感染的患眼视力预后比细菌感染的患眼更有利。近五分之一的EE患眼被摘除眼球。
