Busin M, Cusumano A, Spitznas M
University Eye Hospital, Bonn, Germany.
J Cataract Refract Surg. 1995 Nov;21(6):679-84. doi: 10.1016/s0886-3350(13)80566-4.
Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-grade endophthalmitis after cataract extraction to restore useful vision and prevent recurrence. One anterior chamber lens, one iris-supported lens, and nine posterior chamber lenses were removed. In the eyes with posterior chamber lenses, the posterior capsule was intact; total (n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aqueous humor specimens obtained at surgery were positive for bacteria in five eyes, but scanning electron microscopy showed bacteria on all removed IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 and 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was observed. The results show that negative cultures do not preclude a bacterial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of chronic low-grade endophthalmitis not responsive to medical therapy.
为恢复有用视力并预防复发，对11只白内障摘除术后发生慢性低度眼内炎的眼睛取出了人工晶状体（IOL）。共取出1枚前房型人工晶状体、1枚虹膜支撑型人工晶状体和9枚后房型人工晶状体。在后房型人工晶状体的眼中，后囊膜完整；其中7只眼进行了全囊膜切除术，2只眼进行了部分囊膜切除术。手术时获取的房水标本在5只眼中细菌检测呈阳性，但扫描电子显微镜显示所有取出的人工晶状体及囊袋上均有细菌。最终7只眼的最佳矫正视力达到20/40或更好。3只眼视力下降，在20/50至20/400之间，1只眼仅能数指，这与视网膜脱离（2只眼）和年龄相关性黄斑变性（2只眼）有关。1只眼出现短暂性前房积血。平均随访21个月（范围10至31个月），未观察到炎症复发。结果表明，培养结果阴性并不能排除感染的细菌病因，并且初次取出人工晶状体并进行部分或全囊膜切除术为治疗对药物治疗无反应的慢性低度眼内炎提供了一种手术方法。
