中华眼底病杂志

中华眼底病杂志

内源性肺炎克雷伯杆菌性眼内炎七例

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目的观察分析内源性肺炎克雷伯杆菌性眼内炎(EKPE)的眼部特征及治疗预后。方法回顾分析EKPE 7例8只眼的临床资料。其中,男性3例4只眼,女性4例4只眼。年龄39~76岁,平均年龄57.29岁。双眼发病1例,单眼发病6例。7例患者均无外伤史、手术史,但均存在前驱感染病史、糖尿病、系统性红斑狼疮长期糖皮质激素治疗、肝脓肿、肾功能不全行透析治疗、霍奇金淋巴瘤行化学药物治疗等易感因素。所有患眼均行视力、裂隙灯显微镜及眼底检查,观察其眼部情况。8只眼中,发病后2 d~2周行晶状体切除联合玻璃体切割手术7只眼,手术后眼内注射抗生素;仅给予眼内注射抗生素治疗1只眼。收集手术眼的玻璃体液、前房水进行涂片及培养,同时进行血培养及药物敏感(药敏)试验。根据药敏试验结果给予亚胺培南、美罗培南等碳青霉烯类抗生素,静脉注射1~2周。手术后随访3 d~1年,观察患者的预后情况。结果8只眼中,初次就诊时视力光感4只眼,手动3只眼,0.1者1只眼。前房积脓6只眼,混浊2只眼。均存在玻璃体混浊。眼底可见视盘、黄斑水肿及视网膜血管闭塞等改变。7只手术眼手术后玻璃体液、前房水培养结果均为肺炎克雷伯杆菌。末次随访时,视力无光感、光感、手动、0.05、0.5各1只眼;视力0.05、0.5者为前房混浊的2只眼;眼球摘除1只眼。双眼发病患者因多器官衰竭死亡。结论EKPE以单眼发病居多,可见视盘、黄斑水肿及视网膜血管闭塞等改变;视力预后通常不良,于前房未积脓时进行早期玻璃体切割手术有助于挽救患眼视力。

ObjectiveTo observe and analyze the clinical features and prognosis of endogenous klebsiella pneumoniae endophthalmitis (EKPE).MethodsThis is a retrospective case series study. Seven patients (8 eyes) with EKPE were enrolled in this study. There were 3 males (4 eyes) and 4 females (4 eyes). The ages were from 39 to 76 years, the mean age was 57.29 years. All these cases had no history of trauma and surgery. Meanwhile, they all had some risk factors, such as infection, diabetes mellitus, systemic lupus erythematosus, liver abscess, renal insufficiency undergoing dialysis treatment, Hodgkin lymphoma and so on. All the eyes were undertaken visual acuity, slit lamp and fundus examination to observe the eye conditions. Seven eyes were undertaken pars plana vitrectomy with intravitreal injection of antibiotics from 2 days to 2 weeks after onset. And only one eye was undertaken intravitreal injection of antibiotics without surgery. Microbial stains and culture were performed for 7 eyes using vitreous and aqueous fluid samples from the procedures of vitrectomy. Meanwhile, culture and drug sensitive tests were performed from blood samples. According to the result of the drug sensitive tests, carbapenems such as imipenem and meropenem were used in each patient through intravenous injection from 1 to 2 weeks. During the follow up period from 3 days to 1 year, prognosis was observed at each office visit.ResultsFrom these eight eyes, presenting visual acuity was light perception (4 eyes), hand motion (3 eyes), 0.1 (1 eye). Hypopyon (6 eyes), aqueous fluid opacity (2 eyes) and diffuse vitreous opacity (8 eyes) were found. Changes in fundus like optic disc, macular edema and retinal vascular occlusion could be observed. Cultures of the vitreous and aqueous fluid samples from vitrectomy were all point out to klebsiella pneumoniae. At last office visit, the visual acuity of patients with hypopyon was no light perception (1 eye), light perception (1 eye), hand motion (1 eye). The visual acuity of patients without hypopyon was 0.05 (1 eye) and 0.5(1 eye). Finally, 1 eye was underwent enucleation and one patient with binocular disease was died of multiple organ failure.ConclusionsEKPE is almost unilateral attacked. Changes in fundus like optic disc, macular edema and retinal vascular occlusion can be observed. EKPE is commonly associated with poor visual outcomes. It is useful to save patients’ visual acuity by performing vitrectomy before hypopyon happened.

关键词: 眼内炎/诊断; 眼内炎/治疗; 肺炎克雷伯菌

Key words: Endophthalmitis/diagnosis; Endophthalmitis/therapy; Klebsiella pneumoniae

引用本文: 周佳, 沈玺. 内源性肺炎克雷伯杆菌性眼内炎七例. 中华眼底病杂志, 2018, 34(3): 272-274. doi: 10.3760/cma.j.issn.1005-1015.2018.03.015 复制

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