SUMMARY Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.

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细菌性和真菌性眼内炎 [评论]


摘要 眼内炎是一种严重的眼部感染，可能导致受影响的眼睛永久丧失有用视力。大多数病例是外源性的，是白内障手术、玻璃体内注射或穿透性眼外伤的并发症。内源性眼内炎是由细菌或真菌在眼部血行播散引起的，但菌血症或真菌血症可能是暂时的，患者可能没有全身感染症状。几乎所有眼内炎患者都会出现视力下降，有些还伴有眼痛。眼部检查通常会发现前房积脓和眼内炎症。诊断是临床诊断，由玻璃体和/或房水培养或某些内源性病例中的血培养支持。分子诊断技术已在研究实验室中用于眼内炎病原体鉴定，并提供快速诊断的可能性，包括培养阴性病例。玻璃体内注射抗生素是治疗中最重要的组成部分；有些病例还受益于玻璃体切除术的玻璃体清创术。视觉结果部分取决于病原体：例如，凝固酶阴性葡萄球菌性眼内炎比链球菌性眼内炎的预后更好。眼内炎是一种医疗紧急情况，及时诊断和治疗对于挽救视力至关重要。