Okada A A, Johnson R P, Liles W C, D'Amico D J, Baker A S
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114
Ophthalmology. 1994 May;101(5):832-8.
The purpose of this study is to report the predisposing factors, timing of symptoms, timing of diagnosis, causative organisms, source of infection, and visual outcome in cases of endogenous bacterial endophthalmitis.
The records of 28 patients with endogenous bacterial endophthalmitis who presented to our combined ophthalmology and medicine services over a 10-year period were reviewed.
Ninety percent of the patients had prior medical conditions, including diabetes mellitus, gastrointestinal disorders, hypertension, cardiac disorders, and malignancy. Acute ocular symptoms were the most common reasons why the patient went to the physician (usually an ophthalmologist) rather than systemic symptoms. A correct initial diagnosis was made in 50% of patients, with a delay in diagnosis of 4 days or more in 29% of patients. Organisms were identified in 27 of the 28 patients (96% identification rate), two thirds of which were gram-positive organisms. Streptococcal species were the most common group (32% of patients), although the single most common organism was Staphylococcus aureus (25% of patients). Sources of infection were identified in 93% of patients, with endocarditis and the gastrointestinal tract being the most common. In the majority of patients, visual outcome was poor. However, six eyes that received intravenous and intravitreal antibiotics, as well as therapeutic vitrectomy, achieved visual acuities of 20/50 or better.
These results provide a further understanding of the manner of presentation, organisms involved, and sources of infection in endogenous bacterial endophthalmitis. They also suggest that improved outcome may be associated with early initiation of combined medical and surgical treatment.
本研究旨在报告内源性细菌性眼内炎病例的易感因素、症状出现时间、诊断时间、致病微生物、感染源及视力预后。
回顾了10年间在我们眼科和内科联合门诊就诊的28例内源性细菌性眼内炎患者的病历。
90%的患者有既往病史，包括糖尿病、胃肠道疾病、高血压、心脏疾病和恶性肿瘤。急性眼部症状是患者就医（通常是眼科医生）的最常见原因，而非全身症状。50%的患者做出了正确的初始诊断，29%的患者诊断延迟4天或更长时间。28例患者中有27例（96%的鉴定率）鉴定出了微生物，其中三分之二为革兰氏阳性菌。链球菌属是最常见的菌群（占患者的32%），尽管最常见的单一微生物是金黄色葡萄球菌（占患者的25%）。93%的患者确定了感染源，其中心内膜炎和胃肠道是最常见的。大多数患者的视力预后较差。然而，6只接受静脉和玻璃体内抗生素以及治疗性玻璃体切除术的眼睛，视力达到了20/50或更好。
这些结果进一步加深了我们对内源性细菌性眼内炎的表现方式、相关微生物及感染源的理解。它们还表明，改善预后可能与早期开始联合药物和手术治疗有关。
