Meredith T A, Aguilar H E, Drews C, Sawant A, Gardner S, Wilson L A, Grossniklaus H E
St Louis University School of Medicine, Missouri, USA.
Trans Am Ophthalmol Soc. 1996;94:241-52; discussion 252-7. doi: 10.1016/s0002-9394(14)70164-3.
We created a standardized model of severe Staphylococcus aureus endophthalmitis in the aphakic rabbit eye to test various treatment strategies involving corticosteroid administration in addition to vitrectomy and antibiotic treatment.
In 71 aphakic New Zealand albino rabbit eyes, experimental endophthalmitis was created by injecting 10(5) colony-forming units of Staphylococcal aureus. The animals were divided into 5 groups. One control group was followed up without treatment, while 4 groups were treated with vitrectomy and intraocular cefazolin injection. Two groups were also treated with intramuscular methylprednisolone, 1 group beginning on the day of surgery and 1 group beginning on the following day. In the final group, dexamethasone, 400 micrograms, was injected into the vitreous cavity at the close of surgery. Culture results were compared on the first 2 days after surgery. Inflammatory scores, including development of total corneal opacity, were assessed over a 21-day follow-up period, and histopathologic grading was carried out at the conclusion of the clinical observations.
Simultaneous administration of systemic corticosteroids beginning on the day of vitrectomy decreased inflammatory scores 1 week after institution of therapy but did not affect final scores. Delay of initiation of intramuscular corticosteroid until the first postoperative day negated the positive effects. Administration of intraocular corticosteroids was associated with an increase in inflammatory scores throughout the period of observation, an increase in percentage of eyes that developed opaque corneas, an increase in choroidal inflammation graded moderate or severe, and an increase in retinal necrosis compared with vitrectomy and cefazolin injection alone.
This data suggest caution in the use of intraocular corticosteroids in treatment of severe endophthalmitis.
我们在无晶状体兔眼中创建了严重金黄色葡萄球菌性眼内炎的标准化模型，以测试除玻璃体切割术和抗生素治疗外涉及使用皮质类固醇的各种治疗策略。
在71只无晶状体新西兰白化兔眼中，通过注射10(5)个金黄色葡萄球菌菌落形成单位来制造实验性眼内炎。将动物分为5组。一个对照组不进行治疗而进行随访，而4组接受玻璃体切割术和眼内注射头孢唑林治疗。两组还接受肌肉注射甲泼尼龙治疗，一组在手术当天开始，一组在第二天开始。在最后一组中，在手术结束时向玻璃体腔注射400微克地塞米松。比较术后头2天的培养结果。在21天的随访期内评估炎症评分，包括角膜全层混浊的发展情况，并在临床观察结束时进行组织病理学分级。
在玻璃体切割术当天开始同时给予全身皮质类固醇可在治疗开始1周后降低炎症评分，但不影响最终评分。将肌肉注射皮质类固醇的开始时间推迟到术后第一天会抵消其积极作用。与仅进行玻璃体切割术和注射头孢唑林相比，眼内注射皮质类固醇在整个观察期内与炎症评分增加、出现角膜混浊的眼的百分比增加、脉络膜炎症分级为中度或重度增加以及视网膜坏死增加相关。
这些数据表明在严重眼内炎治疗中使用眼内皮质类固醇时应谨慎。
