摘要
目的分析外源性真菌性眼内炎特征性体征和病原体分布,探索其切实有效的治疗方案,为临床诊治提供依据。方法回顾性分析2010年1月—2018年6月唐山眼科医院治疗的外源性真菌性眼内炎患者13例(13只眼)的临床资料,从病历中采集患者性别、年龄、病程、病史、治疗方式、病原体及最佳矫正视力(BCVA)信息,录入Excel表后进行分类统计,并记录数据。由3位正高级眼科医师重新审阅患者的既往眼科检查结果,并对其特征性体征进行统计描述,同时评估其临床疗效。结果(1)一般情况:13例(13只眼)患者中男性11例(11只眼),女性2例(2只眼),平均年龄(45.42±6.85)岁。平均病程(8.12±3.45)d。均有明确的开放性眼外伤史,其中以植物刺伤者居多。所有患者都接受了新型广谱抗真菌药物(注射用伏立康唑和注射用两性霉素B)联合手术治疗。(2)特征性体征:前房均呈蛛网线样,或棉绒样,或棉团样灰白混浊。其中,伴角膜溃疡似牙膏者2只眼;伴前房积脓者11只眼;角膜灰白浸润伴伪足者11只眼;玻璃体均呈蛛网线状,或棉绒絮样,或棉团样灰白混浊;眼底多灶样黄白色、白色绒样或棉球样改变,视网膜少许出血,严重者视网膜血管白线状。(3)病原体分布:13只眼中,实验室涂片细胞学检查真菌阳性12只眼;病灶标本分离病原体培养出真菌10只眼,其中曲霉菌属5只眼,占比50.00%;镰刀菌属4只眼,占40.00%;酵母菌属1只眼,占比10.00%。(4)临床疗效及并发症:13例患者治疗后,有效10只眼,无效3只眼,有效率为76.92%,BCVA提高,与治疗前比较,差异有统计学意义(t=5.527,P=0.000),均未发生严重并发症。结论外伤史、特征性体征和实验室检查有助于明确诊断,尽早予广谱抗真菌药物联合手术治疗,可以较好地控制外源性真菌性眼内炎。
OBJECTIVE To analyze the characteristics and pathogen distribution of exogenous fungal endophthalmitis,and explore its effective treatment methods,so as to provide basis for clinical diagnosis and treatment.METHODS The clinical data of thirteen patients(thirteen eyes)with exogenous fungal endophthalmitis treated in Tangshan Eye Hospital from January 2010 to June 2018 were retrospectively analyzed.Information including the patients′gender,age,course of disease,medical history,treatment method,pathogen and best corrected visual acuity(BCVA)were collected from the medical records,which were transported into Excel for classified statistics,and the data were recorded.Three senior ophthalmologists were arranged to review the patients’previous ophthalmic examination results,statistically describe the characteristic sign,and evaluate the clinical efficacy.RESULTS(1)General information:Among the thirteen patients(thirteen eyes),there were eleven males(eleven eyes)and two females(two eyes),with an average age of(45.42±6.85)years.The average course of disease was(8.12±3.45)days.All cases were accompanied with a clear history of open eye trauma,most of which were stabbed by plants.All patients received a combination of new broad-spectrum anti-fungal drugs(voriconazole for injection and amphotericin B for injection)and surgery.(2)Characteristic sign:The anterior chamber was presented with cob web-like,cotton wool-like or cotton ball-like gray opacities.Among them,two eyes were presented with toothpaste-like corneal ulcer,eleven eyes were presented with anterior chamber empyema,and eleven eyes were accompanied with corneal gray infiltration with pseudopodia.The vitreous were all presented with cob web-like,or cotton wool-like,or cotton ball-like grey opacities.The fundus showed multi-focal yellowish white,white velvet-like or cotton ball-like changes,few retinal hemorrhage,and in severe cases,retinal blood vessels became white line.(3)Pathogen distribution:Among the thirteen eyes,twelve eyes were positive for fungi examined by laboratory smear cytology.Fungi were isolated from the lesion samples including five eyes of Aspergillus,accounting for 50.00%,four eyes of Fusarium,accounting for 40.00%,and 1 eye of Octomyces,accounting for 10.00%.(4)Clinical efficacy and complications:After treatment,ten eyes were effectively treated,and three eyes were ineffective.The effective rate was 76.92%.BCVA was increased when compared with that before treatment,and the difference was statistically significant(t=5.527,P=0.000).There were no serious complications.CONCLUSIONS Three factors including trauma history,characteristic sign and laboratory examination are helpful to make a clear diagnosis of exogenous fungal endophthalmitis.Early treatment with new broad-spectrum anti-fungal drugs combined with surgery can better control exogenous fungal endophthalmitis.
作者
刘鹏飞
张怀强
LIU Pengfei;ZHANG Huaiqiang(Tangshan Jidong Eye Hospital,Tangshan 063000,China)
出处
《中国中医眼科杂志》
2022年第3期217-221,共5页
China Journal of Chinese Ophthalmology
关键词
外源性
真菌性
眼内炎
病原体检测
玻璃体手术
广谱抗真菌药物
exogenous
fungal
endophthalmitis
pathogen detection
vitrectomy
broad-spectrum anti-fungal drugs
