Foster R E, Rubsamen P E, Joondeph B C, Flynn H W, Smiddy W S
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine.
Ophthalmology. 1994 Mar;101(3):490-8. doi: 10.1016/s0161-6420(94)31308-x.
Eyes with concurrent endophthalmitis and retinal detachment usually have a poor anatomic and visual outcome after treatment. The purpose of this study is to define the relation among the causative organism, the results of retinal detachment repair, and the final visual acuity.
Data were retrieved by a retrospective, computer-assisted review of the coded inpatient diagnoses from April 1987 through March 1992.
This study included 16 patients (9 males, 7 females) ranging in age from 5 to 88 years (average, 58.7 years). Endophthalmitis was classified as exogenous in 13 (81%) patients and endogenous in 3 (19%). Two groups were identified: a virulent group that included eight (50%) patients (Staphylococcus aureus, streptococci, gram-negative, Bacillus), and a less-virulent group that included eight (50%) patients (Staphylococcus epidermidis, Propionibacterium acnes, fungal). The initial surgical procedure consisted of diagnostic vitreous fluid collection by pars plana vitrectomy (11 cases), anterior vitrectomy (1 case), or vitreous aspiration (4 cases). Additional initial adjunctive surgical procedures included pars plana lensectomy (2 cases), scleral buckling (6 cases), fluid-gas exchange (7 cases), and intraocular antibiotic injections (9 cases). In six (75%) of eight patients with endophthalmitis in the virulent group, the retina remained detached. However, in seven (88%) of eight patients with endophthalmitis in the less-virulent group, the retina remained reattached postoperatively, and the remaining patient had a stable, nonprogressive peripheral tractional retinal detachment. None of the eight patients with endophthalmitis in the virulent group retained a postoperative visual acuity of better than 3/200, and four (50%) lost all light perception. Five (62%) of the eight patients with endophthalmitis in the less-virulent group retained a postoperative visual acuity of 5/200 or better, and none lost all light perception.
Concurrent endophthalmitis and retinal detachment patients with virulent organisms have a poor prognosis. Visual and anatomic outcomes were better in the less-virulent group.
并发眼内炎和视网膜脱离的眼睛在治疗后通常解剖和视力预后较差。本研究的目的是明确致病微生物、视网膜脱离修复结果和最终视力之间的关系。
通过对1987年4月至1992年3月编码的住院患者诊断进行回顾性计算机辅助检索获取数据。
本研究包括16例患者（9例男性，7例女性），年龄5至88岁（平均58.7岁）。13例（81%）患者的眼内炎为外源性，3例（19%）为内源性。分为两组：一组为毒性较强组，包括8例（50%）患者（金黄色葡萄球菌、链球菌、革兰阴性菌、芽孢杆菌）；另一组为毒性较弱组，包括8例（50%）患者（表皮葡萄球菌、痤疮丙酸杆菌、真菌）。初始手术操作包括经平坦部玻璃体切除术采集诊断性玻璃体液（11例）、前部玻璃体切除术（1例）或玻璃体抽吸术（4例）。额外的初始辅助手术操作包括平坦部晶状体切除术（2例）、巩膜扣带术（6例）、液-气交换（7例）和眼内抗生素注射（9例）。毒性较强组8例眼内炎患者中有6例（75%）视网膜仍脱离。然而，毒性较弱组8例眼内炎患者中有7例（88%）术后视网膜仍复位，其余1例患者有稳定的、非进行性的周边牵拉性视网膜脱离。毒性较强组8例眼内炎患者术后视力均未超过3/200，4例（50%）患者完全丧失光感。毒性较弱组8例眼内炎患者中有5例（62%）术后视力保持在5/200或更好，无一例完全丧失光感。
并发眼内炎和视网膜脱离且致病微生物毒性较强的患者预后较差。毒性较弱组的视力和解剖学预后较好。
