A multicentre prospective study of post-traumatic endophthalmitis
A multicentre prospective study of post-traumatic endophthalmitis
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DOI：
10.1111/j.1755-3768.2011.02349.x
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发表时间：
2013-08-01
影响因子：
3.4
通讯作者：
Chiquet, Christophe
中科院分区：
文献类型：
--
作者：
Cornut, Pierre-Loic;Youssef, El Bichara;Chiquet, Christophe
。目的：探讨外伤性眼内炎的临床、微生物学特点及影响预后的因素。方法：2004 ~ 2010年纳入17只眼，前瞻性收集临床及微生物学资料。常规培养和泛菌PCR在水和玻璃样品上进行。结果：眼内炎的临床症状在外伤后不久（1.5 +/- 2.5d）出现。53%的患者有眼内异物撕裂伤。入院时，所有患者均有房水（71%）和/或玻璃体（53%）标本。15例患者（88%）行玻璃体切割手术。77%的病例检出细菌：表皮葡萄球菌（n=5）、链球菌（n=4）、芽孢杆菌（n=2）、stuzeri假单胞菌（n=1）、唾液链球菌和溶血链球菌（n=1）。35%的病例进展为肺结核；41%的患者恢复视力（VA） 20/40。良好的最终视力预后（20/40）与初始VA优于光感（0%对70%，p=0.01）和瞳孔纤维蛋白膜缺失（80%对20%，p=0.05）显著相关。视力预后与年龄、撕裂类型（角膜或巩膜）或IOFB的存在没有相关性。我们发现了细菌毒力与最终VA差之间的统计学趋势。结论：该系列研究表明，在临床过程中，较好的最终VA结果与初始VA好于光感知、表皮棘球菌或培养阴性病例和无视网膜脱离相关。
. Purpose: Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis. Methods: Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples. Results: Clinical signs of endophthalmitis were observed soon after trauma (1.5 +/- 2.5days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and/or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n=5), Streptococcus (n=4), Bacillus (n=2), Pseudomonas stuzeri (n=1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n=1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) 20/40. A good final visual prognosis (20/40) was significantly associated with initial VA better than light perception (0% versus 70%, p=0.01) and absence of pupillary fibrin membrane (80% versus 20%, p=0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA. Conclusion: This series showed that better final VA outcomes were associated with initial VA better than light perception, S.epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.