内源性眼内炎的临床特征及预后分析
Clinical characteristics and prognosis analysis of endogenous endophthalmitis
李营营 1陈放 1朱俊1
作者信息
- 1. 江苏省苏北人民医院眼科,扬州 225001
- 折叠
摘要
目的 观察内源性眼内炎的临床特征、治疗方法及预后.方法 回顾性病例系列研究.收集 2010 年 9 月至 2023 年 9 月于江苏省苏北人民医院确诊为内源性眼内炎且原发病灶明确的20 例(25 眼)患者的临床资料,分析患者初诊时全身与眼部临床表现、原发病灶、病原微生物、治疗方法及患者预后转归情况.采用Logistic回归分析性别、年龄、糖尿病、血糖控制情况、初始视力、原发病灶、病原微生物、发病至玻璃体切除术(PPV)时间及确诊至PPV时间等因素对内源性眼内炎患者视功能预后的影响.结果 本研究内源性眼内炎患者于该院初诊时 96.00%(24/25)的患眼最佳矫正视力(BCVA)低于 0.05,18 例(90.00%)内源性眼内炎患者合并糖尿病病史,16 例(80.00%)患者发病时有发热感冒等前驱症状,主诉均为视力下降,大多伴有眼红、眼痛(19/25,76.00%).内源性眼内炎患者原发病灶以肝脓肿最常见(15/20,75.00%).19 例(19/20,95.00%)患者培养出病原微生物,其中肺炎克雷伯杆菌最常见(15/19,78.95%).原发灶病原微生物培养阳性率为 81.25%(13/16),眼内液培养阳性率为 47.37%(9/19),血培养阳性率为 45.00%(9/20),但差异无统计学意义(χ2=4.31,P=0.237).本研究内源性眼内炎患者最终 3 例死亡.7 例(7 眼)(7/25,28.00%)行眼内容摘除术,10 例(14 眼)(14/25,56.00%)感染控制,保留不同程度的视力,最终视力(logMAR)为 1.59±0.88.本研究行玻璃体切除术治疗者 12 眼,患者初始视力(logMAR)为 2.3(2.0,2.6),治疗后视力提高至 2.0(1.3,2.3),差异有统计学意义(Z=-2.15,P=0.032).年龄≥50 岁(OR=14.00,95%CI:1.14～172.64,P=0.039)、初始视力无光感(OR=27.00,95%CI:1.14～637.86,P=0.041)、血糖控制不佳(OR=24.00,95%CI:1.74～330.80,P=0.018)及确诊至PPV时间≥3 d(OR=82.33,95%CI:2.88～2 352.60,P=0.010)为内源性眼内炎患者眼内容摘除术的危险因素.结论 年龄≥50 岁、初始视力无光感、血糖控制不佳及确诊至PPV时间≥3 d为内源性眼内炎患者眼内容摘除术的危险因素,也是最终视力无光感的危险因素.及时有效的手术治疗及血糖的控制对于改善内源性眼内炎预后至关重要.
Abstract
Objective To observe the clinical characteristics as well as treatment and prognosis of endogenous endophthalmitis.Methods This was a retrospective case series study.The clinical data of 20 patients(25 eyes)diagnosed as endogenous endophthmitis with confirmed primary lesions registered in Northern Jiangsu People's Hospital from Sep.2010 to Sep.2023 were collected.The systemic and ocular clinical manifestations at initial diagnosis,primary lesions,pathogenic microorganisms,treatment methods and prognosis were analyzed.Factors such as gender,age,diabetes,blood glucose control,initial vision,primary lesion,pathogenic microorganism,days from onset to pars plana vitrectomy(PPV)and days from diagnosis data to PPV were analyzed in patients with endogenous endophthalmitis by Logistic regression analysis.Results In this study,96.00%(24/25)of patients with endogenous endophthalmitis had best corrected visual acuity of less than 0.05 at the initial diagnosis,and 18 patients(90.00%)with endogenous endophthalmitis had a history of diabetes.Sixteen patients(80.00%)had prodromal symptoms such as fever and cold at the time of onset.The main complaint was decreased vision,most of which were accompanied by redness and eye pain(19/25,76.00%).Liver abscess was the most common primary lesion in patients with endogenous endophthalmitis(15/20,75.00%).Pathogenic microorganisms were cultured in 19 patients(19/20,95.00%),of which Klebsiella pneumoniae was the most common one(15/19,78.95%).The positive rate of pathogenic microorganism culture in primary lesions was 81.25%(13/16),and the positive rate of intraocular fluid culture was 47.37%(9/19),while the positive rate of blood culture was 45.00%(9/20),but the difference was not statistically significant(χ2=4.31,P=0.237).In this study,3 patients with endogenous endophthalmitis eventually died,and 7 eyes(7/25,28.00%)underwent evisceration of eye contents,while 14 eyes(14/25,56.00%)had infection control,and maintained different degrees of visual acuity.The final visual acuity(logMAR)of endogenous endophthalmitis was 1.59±0.88.In this group,12 eyes were treated with pars plana vitrectomy.The initial visual acuity(logMAR)was 2.3(2.0,2.6),and visual acuity improved to 2.0(1.3,2.3)after treatment,which was significantly better than that before surgery,and the difference was statistically significant(Z=-2.15,P=0.032).Age≥50 years old(OR=14.00,95%CI:1.14-172.64,P=0.039),no light perception in initial visual acuity(OR=27.00,95%CI:1.14-637.86,P=0.041),poor blood glucose control(OR=24.00,95%CI:1.74-330.80,P=0.018)and days from diagnosis to PPV≥3 days(OR=82.33,95%CI:2.88-2 352.60,P=0.010)were risk factors for enucleation of ocular contents in patients with endogenous endophthalmitis,and also risk factors for no light perception in final visual acuity(all P<0.05).Conclusion Age≥50 years old,no light perception in initial visual acuity,poor blood glucose control and days from diagnosis to PPV≥3 days are risk factors for enucleation of ocular contents in patients with endogenous endophthalmitis,and also risk factors for no light perception in final visual acuity.Timely and effective surgical treatment and blood glucose control are essential to improve the prognosis of endogenous endophthalmitis.
关键词
眼内炎,内源性/治疗/预后/玻璃体切除术/脓肿,肝/杆菌,克雷伯,肺炎Key words
Endophthalmitis,endogenous/Treatment/Prognosis/Vitrectomy/Abscess,liver/Bacillus,klebsiella,pneumonia引用本文复制引用
出版年
2024
NETL
NSTL
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