Winward K E, Pflugfelder S C, Flynn H W, Roussel T J, Davis J L
Department of Ophthalmology, University of Miami School of Medicine, Bascom Palmer Eye Institute, Florida.
Ophthalmology. 1993 Apr;100(4):447-51. doi: 10.1016/s0161-6420(93)31624-6.
Postoperative Propionibacterium endophthalmitis is a condition characterized by exacerbations and remissions that has often been accompanied by recurrence after treatment. The purpose of this study is to evaluate the efficacy of initial therapies in preventing recurrent endophthalmitis and to assess the safety of intraocular lens (IOL) exchange performed during treatment of active endophthalmitis.
The records of 22 patients with culture-proven Propionibacterium endophthalmitis treated at one facility were retrospectively reviewed.
Two patients presented acutely, were treated with intraocular antibiotic injection alone, and experienced no recurrent inflammation. Twenty patients presented with chronic, delayed-onset pseudophakic endophthalmitis. Eight of these were treated initially with intraocular antibiotic injection alone, and recurrent endophthalmitis developed in seven. Twelve patients with chronic endophthalmitis were initially managed surgically with either pars plana vitrectomy or IOL exchange. Four of the 12 experienced recurrent endophthalmitis. Patients undergoing capsulectomy as part of initial management experienced the lowest rate of recurrent endophthalmitis. Eight patients eventually underwent total capsulectomy and IOL explantation, seven of whom had IOL exchange. None of these eight patients had recurrent endophthalmitis. In seven of the eight, persistent bacterial colonization of the lens capsular remnants was demonstrated.
These data suggest that recurrent Propionibacterium endophthalmitis is due to persistence of viable organisms sequestered within lens capsular remnants, and that initial therapy directed toward surgical removal of these sequestered organisms results in a reduced frequency of recurrent endophthalmitis. Intraocular lens exchange with complete capsular removal during active endophthalmitis was not associated with recurrent or persistent endophthalmitis.
术后丙酸杆菌性眼内炎是一种具有病情加重与缓解特点的疾病，治疗后常伴有复发。本研究的目的是评估初始治疗在预防复发性眼内炎方面的疗效，并评估在活动性眼内炎治疗期间进行人工晶状体（IOL）置换的安全性。
回顾性分析在一家机构接受治疗的22例经培养证实为丙酸杆菌性眼内炎患者的病历。
2例急性发病患者仅接受了眼内抗生素注射治疗，未出现复发性炎症。20例患者表现为慢性、迟发性假晶状体眼内炎。其中8例最初仅接受眼内抗生素注射治疗，7例发生了复发性眼内炎。12例慢性眼内炎患者最初接受了玻璃体切除术或IOL置换手术治疗。12例中的4例发生了复发性眼内炎。作为初始治疗一部分接受囊膜切除术的患者复发性眼内炎发生率最低。8例患者最终接受了全囊膜切除术和IOL摘除术，其中7例进行了IOL置换。这8例患者均未发生复发性眼内炎。8例中的7例显示晶状体囊膜残余存在持续性细菌定植。
这些数据表明，复发性丙酸杆菌性眼内炎是由于存活的病原体隐匿在晶状体囊膜残余内持续存在所致，针对手术清除这些隐匿病原体的初始治疗可降低复发性眼内炎的发生率。在活动性眼内炎期间进行IOL置换并完全清除囊膜与复发性或持续性眼内炎无关。
