Endophthalmitis.
Endophthalmitis.
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DOI：
10.1111/1469-0691.12118
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Durand ML
中科院分区：
文献类型：
--
作者：
Durand ML
眼内炎是指眼内的细菌或真菌感染，累及玻璃体和/或房水。大多数病例是外源性的，发生在眼部手术后，穿透性眼外伤后，或作为角膜感染的延伸。越来越多的病例发生在玻璃体内注射抗血管内皮生长因子（VEGF）药物后。眼内炎也可能是内源性的，由细菌性或真菌性眼内接种引起。然而，受感染的眼睛绝不会成为菌血症或真菌血症的来源。眼内炎中最常见的病原体因类别而异。凝固酶阴性葡萄球菌是白内障后眼内炎最常见的病因，而这些细菌和草绿色链球菌是玻璃体内注射抗VEGF后眼内炎的主要病因，蜡样芽孢杆菌是外伤后眼内炎的主要病因，金黄色葡萄球菌和链球菌是心内膜炎相关的内源性眼内炎的重要病因。在台湾和其他东亚国家，肺炎克雷伯菌引起大多数内源性眼内炎，并伴有肝脓肿。住院患者的内源性真菌性眼内炎通常由念珠菌属，特别是白色念珠菌引起。急性眼内炎是一种医疗急症。治疗的最重要组成部分是玻璃体内注射抗生素，沿着严重病例的玻璃体切除术。内源性眼内炎和外源性真菌性眼内炎应全身应用抗生素，但其在外源性细菌性眼内炎中的作用尚不确定。如果对初始治疗没有反应，则可能需要重复玻璃体内注射抗生素。许多眼睛接受及时和适当的治疗将恢复有用的视力。
Endophthalmitis means bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humors. Most cases are exogenous and occur after eye surgery, after penetrating ocular trauma, or as an extension of corneal infection. An increasing number of cases are occurring after intravitreal injections of anti-vascular endothelial growth factor (VEGF) medications. Endophthalmitis may also be endogenous, arising from bacteraemic or fungaemic seeding of the eye. The infected eye never serves as a source of bacteraemia or fungaemia, however. The most common pathogens in endophthalmitis vary by category. Coagulase-negative staphylococci are the most common causes of post-cataract endophthalmitis, and these bacteria and viridans streptococci cause most cases of post-intravitreal anti-VEGF injection endophthalmitis, Bacillus cereus is a major cause of post-traumatic endophthalmitis, and Staphylococcus aureus and streptococci are important causes of endogenous endophthalmitis associated with endocarditis. In Taiwan and other East Asian nations, Klebsiella pneumoniae causes most cases of endogenous endophthalmitis, in association with liver abscess. Endogenous fungal endophthalmitis in hospitalized patients is usually caused by Candida species, particularly Candida albicans. Acute endophthalmitis is a medical emergency. The most important component of treatment is the intravitreal injection of antibiotics, along with vitrectomy in severe cases. Systemic antibiotics should be used in cases of endogenous endophthalmitis and exogenous fungal endophthalmitis, but their role in exogenous bacterial endophthalmitis is uncertain. Repeated intravitreal injections of antibiotics may be necessary if there is no response to the initial therapy. Many eyes that receive prompt and appropriate treatment will recover useful vision.
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