网络首发:2016-10-14,
纸质出版:2016
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31例儿童外伤感染性眼内炎病因及治疗效果分析[J]. 中山大学学报(医学科学版), 2016,37(5).
31 Cases of Pediatric Endophthalmitis Caused by Traumatic Infection: Etiology and Curative Effect Analysis[J]. Journal of Sun Yat-sen University (Medical Sciences), 2016, 37(5).
【目的】 分析总结儿童眼外伤感染性眼内炎的临床特点,探讨儿童眼内炎最佳治疗时间和方案。【方法】 回顾性分析2012年11月至2014年8月在中山大学中山眼科中心作者诊治的儿童外伤性感染性眼内炎31例(31只眼)的临床资料,总结其临床特征和治疗方法。【结果】 31例患儿,男性26例,女性5例,年龄1~12岁,平均年龄5.4岁,幼儿组4人、学龄前组13人、学龄组13人。根据患儿眼内炎的病变程度,分别选择静脉注射抗生素(4例)、玻璃体手术联合玻璃体腔注射抗生素(10例)、玻璃体手术联合眼内硅油填充(16例)和玻璃体手术联合眼内惰性气体填充(1例)等治疗方法。治疗效果:良好19例(61.29%),硅油依赖6例(19.35%);眼球萎缩或低眼压6例(19.35%)。本组儿童致伤原因较多,幼儿主要是家用锐器,学龄前及学龄儿童以学习用具为主。本组儿童眼内炎病原菌培养检出率低(37.04%)、耐药菌多,G+ 球菌是主要感染菌种(50%),存在复合菌种感染(10%)。头孢他啶静脉滴注联合左氧氟沙星局部频繁滴眼可有效控制细菌性感染, 10 d内接受玻璃体手术治疗的预后优于10 d后接受手术治疗(P < 0.05),使用抗生素药物的早与晚均不影响患者预后(P > 0.05)。【结论】 早期玻璃体手术是决定儿童眼内炎预后的关键,玻璃体手术联合硅油填充是挽救重度眼内炎最有效的措施。
【Objective】 To investigate the clinical feature of paediatric posttraumatic endophthalmitis and discuss the optimal treatment plan.【Methods】 We performed a retrospective review of thirty -one cases (31 eyes) of paediatric posttraumatic endophthalmitis treated at Zhongshan Ophthalmic Center, SUN Yat -sen University from November 2012 to August 2014. The clinical features, causes of trauma, therapeutic options and prognosis were analyzed. 【Results】 Of 31 cases (male 26 , female 5), who aged from 1 to 12 years, the average age was 5.4 years. They were divided into infant group (4 cases), preschool group (13 cases) and school group (13 cases). According to the stage of the infection of each patient, 4 patients received intravenous injection with antibiotics, while vitrectomy with antibiotic injection was administrated for 10 patients, vitrectomy with silicone oil tamponade for 16 patients and vitrectomy with inert gas tamponade for 1 patient. In follow -up examination,19 patients(61.29%) had good visual acuity, 6 patients (19.35% ) with silicone oil dependence,and the other 6 patients(19.35%) with eyeball atrophy or low intraocular pressure. Posttraumatic endophthalmitis in infant group was usually caused by sharp items, in preschool and school group was caused by different items, and the most common was school things. The detection rate of pathogenic bacteria culture was quite low (37.04%), Gram -positive cocci were the main causes of posttraumatic endophthalmitis and polymicrobial infection was obviously present. Bacterial infection could be effectively controlled by intravenous infusion of ceftazidime and combined with local levofloxacin frequent eye drops. Patients received vitrectomy within ten days had better prognosis (P < 0.05), and there is no difference on when to start using antibiotics (P > 0.05). 【Conclusion】 Children with posttraumatic endophthalmitis undergoing vitrectomy as early as possible is the key to better prognosis and the optimal treatment measure is vitrectomy with silicone oil tamponade for serious cases.
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