Scott I U, Flynn H W, Feuer W, Pflugfelder S C, Alfonso E C, Forster R K, Miller D
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA.
Ophthalmology. 1996 Nov;103(11):1864-70. doi: 10.1016/s0161-6420(96)30415-6.
The purpose of the study is to investigate possible risk factors, organisms cultured, and visual acuity outcomes of endophthalmitis associated with microbial keratitis.
Records were reviewed of all patients with both positive corneal and positive intraocular cultures at the Bascom Palmer Eye Institute between January 1, 1990, and March 31, 1995.
Thirteen (92.9%) of 14 patients identified had documented keratitis before the diagnosis of endophthalmitis was made. Thirteen (92.9%) patients recently had used 1% prednisolone acetate eye drops, 2 (14.3%) received oral prednisone, and 5 (35.7%) were being treated for systemic conditions associated with relative immune dysfunction. Eight (57.1%) patients had a history of ocular surgery, and seven (50.0%) had wound abnormalities. Eight (57.1%) patients lacked an intact posterior capsule, four (28.6%) had a corneal perforation, and three (21.4%) had a history of dry eye. Gram-negative organisms (7), Staphylococcus aureus (3), streptococcal species (2), and fungi (4) were the most frequently isolated organisms. Coagulase-negative staphylococci were not isolated. Six (42.9%) patients achieved a post-treatment visual acuity of 20/200 or better. Three (21.4%) patients underwent enucleation or evisceration. Although not statistically significant, there was an association between appropriate initial antibiotic therapy and improved visual outcomes.
Patients in whom endophthalmitis associated with microbial keratitis develops have a frequent history of corticosteroid use, systemic conditions associated with relative immune dysfunction, lack of an intact posterior capsule, dry eye, wound abnormalities, and/or corneal perforation. In general, agents cultured consisted of organisms less frequently reported to be the causative agents in series of postoperative and post-traumatic endophthalmitis. Post-treatment visual outcomes generally were poor.
本研究旨在调查与微生物性角膜炎相关的眼内炎的可能危险因素、培养出的微生物以及视力预后情况。
回顾了1990年1月1日至1995年3月31日期间在巴斯科姆·帕尔默眼科研究所角膜和眼内培养结果均为阳性的所有患者的记录。
确诊为眼内炎之前，14例确诊患者中有13例（92.9%）有角膜炎记录。13例（92.9%）患者近期使用过1%醋酸泼尼松龙滴眼液，2例（14.3%）接受过口服泼尼松治疗，5例（35.7%）正在接受与相对免疫功能障碍相关的全身性疾病治疗。8例（57.1%）患者有眼科手术史，7例（50.0%）有伤口异常情况。8例（57.1%）患者后囊膜不完整，4例（28.6%）有角膜穿孔，3例（21.4%）有干眼病史。革兰氏阴性菌（7例）、金黄色葡萄球菌（3例）、链球菌属（2例）和真菌（4例）是最常分离出的微生物。未分离出凝固酶阴性葡萄球菌。6例（42.9%）患者治疗后的视力达到20/200或更好。3例（21.4%）患者接受了眼球摘除术或眼内容剜除术。虽然无统计学意义，但适当的初始抗生素治疗与改善视力预后之间存在关联。
发生与微生物性角膜炎相关的眼内炎的患者常有使用皮质类固醇的病史、与相对免疫功能障碍相关的全身性疾病、后囊膜不完整、干眼、伤口异常和/或角膜穿孔。一般来说，培养出的病原体在一系列术后和创伤后眼内炎中较少被报告为致病病原体。治疗后的视力预后通常较差。
