Chou F F, Kou H K
Department of Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
J Am Coll Surg. 1996 Jan;182(1):33-6.
Endogenous endophthalmitis has been associated with pyogenic hepatic abscess in several recent anecdotal reports. The purpose of this study was to determine the incidence of endophthalmitis associated with pyogenic hepatic abscess, identify the degree of association with Klebsiella pneumoniae as a causative organism, and determine the outcome of treatment.
A retrospective study was performed of 352 consecutive patients with a clinical diagnosis of pyogenic hepatic abscess who had been admitted to Chang Gung Memorial Hospital in Kaohsiung between 1986 and 1993. Findings from complete ophthalmologic evaluations and treatment results were recorded.
Eleven patients (3.1 percent) with endogenous endophthalmitis (monocular in eight and binocular in three) were found among the 352 cases of pyogenic hepatic abscess. Seven of the patients had diabetes mellitus and their blood glucose was poorly controlled. Only one patient had an intrahepatic stone as the cause of hepatic abscess, the other abscesses were of cryptogenic origin. The causative organism was mainly K. pneumoniae and the diagnosis was made by blood culture in ten patients, hepatic aspirate culture in seven, and vitreous contents culture in three. Systemic antibiotics were given in all patients with endogenous endophthalmitis. Percutaneous catheter drainage for hepatic abscess under echo guidance was performed in seven patients, medical treatment only was performed in three patients, and percutaneous tapping of abscess was done in one patient. All 11 patients were alive at the time of writing. Intravitreous culture followed by injection of antibiotics and steroids was immediately undertaken if septic endophthalmitis was suspected, except in two patients, who lost vision before any treatment was given. In five patients, cefamezin and gentamicin were given, and in four patients vancomycin, amikacin, and dexamethasone were given every three days if necessary. Finally, among the total of 14 eyes, there was blindness in ten, three of these had no light perception initially. In seven patients there had been a delay of treatment longer than one day. In one eye there was "counting fingers" vision and in three eyes there remained some vision.
Physicians should be alert to the development of endogenous endophthalmitis when a patient with pyogenic hepatic abscess or bacteremia complains of ocular symptoms. Prompt diagnosis and vigorous treatment with intravitreous injections of vancomycin, amikacin, and dexamethasone within 24 hours can save the patient's eyes and vision.
在最近几篇病例报告中，内源性眼内炎与化脓性肝脓肿相关。本研究的目的是确定与化脓性肝脓肿相关的眼内炎发病率，明确肺炎克雷伯菌作为病原体的关联程度，并确定治疗结果。
对1986年至1993年间高雄长庚纪念医院收治的352例临床诊断为化脓性肝脓肿的连续患者进行回顾性研究。记录完整眼科评估的结果和治疗结果。
在352例化脓性肝脓肿病例中发现11例（3.1%）患有内源性眼内炎（单眼8例，双眼3例）。其中7例患者患有糖尿病且血糖控制不佳。仅1例患者因肝内结石导致肝脓肿，其他脓肿病因不明。病原体主要为肺炎克雷伯菌，10例患者通过血培养确诊，7例通过肝穿刺抽吸培养确诊，3例通过玻璃体内容物培养确诊。所有内源性眼内炎患者均接受了全身抗生素治疗。7例患者在超声引导下进行了经皮肝脓肿导管引流，3例患者仅接受了药物治疗，1例患者进行了经皮脓肿穿刺。撰写本文时，所有11例患者均存活。如果怀疑为感染性眼内炎，除2例在未接受任何治疗前失明的患者外，均立即进行玻璃体培养，随后注射抗生素和类固醇。5例患者给予头孢美唑和庆大霉素，4例患者必要时每三天给予万古霉素、阿米卡星和地塞米松。最后，在总共14只眼中，10只眼失明，其中3只最初无光感。7例患者的治疗延迟超过1天。1只眼有“数指”视力，3只眼仍有一定视力。
当化脓性肝脓肿或菌血症患者出现眼部症状时，医生应警惕内源性眼内炎的发生。在24小时内进行快速诊断并积极给予玻璃体注射万古霉素、阿米卡星和地塞米松治疗，可挽救患者的眼睛和视力。
