Post-traumatic fungal endophthalmitis - a prospective study
Post-traumatic fungal endophthalmitis - a prospective study
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DOI：
10.1038/sj.eye.6702463
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发表时间：
2008-01-01
期刊：
影响因子：
3.9
通讯作者：
Saha, I.
中科院分区：
文献类型：
--
作者：
Gupta, A.;Srinivasan, R.;Saha, I.
目的 研究开放性眼球损伤后真菌性眼内炎的发病率、临床表现和抗真菌药物的反应。方法这是一项前瞻性研究，对 2003 年 8 月至 2005 年 1 月期间因开放性眼球损伤就诊的 110 名患者中的 8 例外伤后真菌性眼内炎进行了研究。对玻璃体内两性霉素反应不足的患者给予玻璃体内咪康唑。结果 两名患者在就诊时患有全眼炎并被摘除内脏。从八名患者的眼内标本培养物中分离出六种不同的微生物。玻璃体抽吸物的产率为87.5%，水性抽吸物的产率为66.6%。曲霉属 sp.和镰刀菌属。 62.5%的病例被隔离。两性霉素B和咪康唑对除淡紫拟青霉和茄病镰刀菌以外的所有微生物的最低抑菌浓度分别小于3μg/ml。总共有37.5%的患者最终视力达到20/400或更好。 结论 真菌性眼内炎是开放性眼球损伤相对罕见的并发症。真菌性眼内炎后的最终视力结果令人沮丧。烟曲霉被发现是毒性最强的生物体。发现所有生物体都对两性霉素 B 敏感，但除淡紫青霉外，它对咪康唑敏感。可能需要重复玻璃体内注射来控制感染。生物体的毒力和损伤部位是最终视觉结果的主要决定因素。
Purpose To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.Methods This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.Results Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 mu g/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.Conclusions Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.