Yokoi M, Hyodo T, Horimoto M, Kase M
Department of Ophthalmology, Teine Keijinkai Hospital.
Hokkaido Igaku Zasshi. 1993 Jul;68(4):583-8.
We treated eight eyes of five patients with mycotic endophthalmitis. Intraocular inflammatory changes in one of these eyes improved only by antifungal therapy with 21-day administration of miconazole and fluconazole. The other seven eyes underwent vitrectomy, and the preoperative periods between the onset of ocular complications and the operation ranged from one and a half months to three months, during which time fungi were isolated only in one case. Dense vitreous opacities caused by the colonies of the fungi were found in the all vitrectomized eyes. Vitrectomy in the three cases showing no retinal detachment was effective for the improvement of either visual acuity or ophthalmoscopic findings, whereas vitrectomy was not effective in the other two cases with the occurrence of the pre-retinal membrane causing traction retinal detachment. The present investigations suggest that persistent endophthalmitis and the appearance of total retinal detachment made the improvement of retinal changes difficult because of the inflammatory and fibrotic processes between the retina and the vitreous body. It, therefore, is shown that anti-fungal therapy should be initiated when mycotic endophthalmitis is suspected, but in cases without response to the drug, vitrectomy should be performed before retinal detachment occurs.
我们对5例真菌性眼内炎患者的8只眼进行了治疗。其中1只眼的眼内炎症变化仅通过咪康唑和氟康唑21天的抗真菌治疗得到改善。另外7只眼接受了玻璃体切除术，眼部并发症发作至手术的术前时间为1个半月至3个月，在此期间仅1例分离出真菌。所有接受玻璃体切除术的眼中均发现由真菌菌落引起的致密玻璃体混浊。3例未发生视网膜脱离的病例，玻璃体切除术对视力或眼底检查结果的改善有效，而另外2例发生视网膜前膜导致牵引性视网膜脱离的病例，玻璃体切除术无效。目前的研究表明，由于视网膜与玻璃体之间的炎症和纤维化过程，持续性眼内炎和完全性视网膜脱离的出现使视网膜病变的改善变得困难。因此，表明当怀疑有真菌性眼内炎时应开始抗真菌治疗，但在对药物无反应的情况下，应在视网膜脱离发生前进行玻璃体切除术。
