Wu Donghai, Lin Yuan, Wu Huping, Cai Jinhong
Xiamen Eye Center and Eye Institute of Xiamen University, School of Medicine, Xiamen, China.
Xiamen Clinical Research Center for Eye Diseases, Xiamen, China.
Front Med (Lausanne). 2024 Dec 9;11:1466530. doi: 10.3389/fmed.2024.1466530. eCollection 2024.
To evaluate systemic inflammatory markers in cases of exogenous endophthalmitis caused by metal foreign bodies after penetrating eye injury and identify risk factors for poor control post-initial emergency surgery.
Twenty-nine patients with exogenous endophthalmitis underwent emergency surgery with vitrectomy at Xiamen Eye Center (2016-2024). Evaluations included systemic inflammatory markers, microbiology, clinical presentation, treatment strategies, complications, prognostic factors, and visual outcomes. Correlation analysis was performed between blood test results and disease control after initial surgery.
The median patient age was 44.8 ± 16.9 years, with an average treatment delay of 6.1 ± 10.6 days. Males represented 86.2% ( = 25), and 41.3% ( = 12) had metallic intraocular foreign bodies, which correlated with faster symptom onset ( < 0.05) and higher inflammatory markers (WBC, neutrophils, basophils, CRP; < 0.05). Primary lens extraction and intraoperative vancomycin did not significantly improve control ( > 0.05). Poor control post-vitrectomy was positively correlated with intraocular foreign bodies ( = 0.39, < 0.05) and negatively with lymphocyte and monocyte counts ( = -0.43, < 0.05; = -0.46, < 0.05). Early intervention within 2 h of symptom exacerbation reduced complication risk (AUC = 0.708, 95% CI: 0.547-0.838, = 0.047).
Metallic intraocular foreign bodies provoke stronger systemic inflammatory responses, posing control challenges, especially in patients with lower immune resilience. Timely vitrectomy during initial emergency surgery is crucial for managing endophthalmitis.
评估穿透性眼外伤后金属异物所致外源性眼内炎患者的全身炎症标志物，并确定初次急诊手术后控制不佳的危险因素。
29例外源性眼内炎患者于2016年至2024年在厦门眼科中心接受了玻璃体切除急诊手术。评估内容包括全身炎症标志物、微生物学、临床表现、治疗策略、并发症、预后因素和视力结果。对初次手术后的血液检测结果与疾病控制情况进行相关性分析。
患者中位年龄为44.8±16.9岁，平均治疗延迟时间为6.1±10.6天。男性占86.2%（n = 25），41.3%（n = 12）有金属性眼内异物，这与症状发作更快（P < 0.05）和炎症标志物（白细胞、中性粒细胞、嗜碱性粒细胞、C反应蛋白）水平更高相关（P < 0.05）。一期晶状体摘除和术中使用万古霉素对控制效果改善不显著（P > 0.05）。玻璃体切除术后控制不佳与眼内异物呈正相关（r = 0.39，P < 0.05），与淋巴细胞和单核细胞计数呈负相关（r = -0.43，P < 0.05；r = -0.46，P < 0.05）。症状加重后2小时内进行早期干预可降低并发症风险（AUC = 0.708，95% CI：0.547 - 0.838，P = 0.047）。
金属性眼内异物引发更强的全身炎症反应，给控制带来挑战，尤其是在免疫恢复力较低的患者中。初次急诊手术时及时进行玻璃体切除术对于治疗眼内炎至关重要。
