Margo C E, Mames R N, Guy J R
Department of Ophthalmology, University of South Florida College of Medicine, Tampa 32610.
Ophthalmology. 1994 Jul;101(7):1298-301. doi: 10.1016/s0161-6420(94)31176-6.
Endogenous endophthalmitis is a rare complication of gram-negative sepsis. The diagnosis often is delayed unless a high index of suspicion exists. Familiarity with the clinical setting in which endogenous Klebsiella endophthalmitis occurs will hasten diagnosis and may improve outcome.
The authors reviewed the medical literature and describe two patients with diabetes who lost vision from endogenous Klebsiella endophthalmitis.
One patient lost all vision in both eyes before the diagnosis of sepsis was clinically suspected. In the other, endophthalmitis was the only clinical sign of septicemia 8 days after hospital discharge for treatment of a Klebsiella urinary tract infection. Survey of the literature showed an increase in the number of cases of endogenous Klebsiella endophthalmitis reported over the last 12 years. Sixty-one percent of the 44 patients reported in the literature since 1981 had diabetes, 68% had suppurative liver disease, and 16% had urinary tract infection.
An important implication of these associations is that metastatic Klebsiella endophthalmitis must be considered when vitritis occurs in patients with diabetes, particularly in those with acute liver disease or a urinary tract infection, or in any patient with vitritis and suppurative liver disease.
内源性眼内炎是革兰氏阴性菌败血症的一种罕见并发症。除非高度怀疑，否则诊断往往会延迟。熟悉内源性克雷伯菌性眼内炎发生的临床情况将加快诊断并可能改善预后。
作者回顾了医学文献并描述了两名因内源性克雷伯菌性眼内炎而失明的糖尿病患者。
一名患者在临床怀疑败血症诊断之前双眼完全失明。另一名患者在因克雷伯菌尿路感染出院治疗8天后，眼内炎是败血症的唯一临床体征。文献调查显示，在过去12年中，内源性克雷伯菌性眼内炎的报告病例数有所增加。自1981年以来文献报道的44例患者中，61%患有糖尿病，68%患有化脓性肝病，16%患有尿路感染。
这些关联的一个重要意义是，当糖尿病患者，特别是患有急性肝病或尿路感染的患者，或任何患有玻璃体炎和化脓性肝病的患者出现玻璃体炎时，必须考虑转移性克雷伯菌性眼内炎。
