盐酸万古霉素综合方案治疗眼内炎

Study of the norvancomycin integrity treatment in bacterial endophthalmitis

摘要:

目的：探讨盐酸万古霉素综合方案治疗眼内炎的临床疗效和并发症。 方法：收集我院2009-07/2011-08眼内炎住院患者27例27眼，采用盐酸万古霉素综合治疗方案进行治疗。所有患者取玻璃体做细菌培养和药敏试验。采用玻璃体腔内注射盐酸万古霉素，全身使用盐酸万古霉素联合左旋氧氟沙星。炎症无明显好转者，2~4d后行玻璃体切割术，术中使用含盐酸万古霉素的灌注液。术后观察视力、眼压、前房和玻璃体混浊情况。对术后最佳矫正视力和眼压进行统计学分析。 结果：患者27例眼内炎均治愈，视力均有提高。细菌培养检出率56%。革兰氏阳性菌占67%，对盐酸万古霉素敏感。革兰氏阴性菌对氧氟沙星较敏感。8例患者经过静脉滴注及玻璃体腔内注药后眼内炎症控制，19例行玻璃体切割手术。术后最佳矫正视力提高。临床症状体征好转。 结论：早期细菌培养对眼内炎的治疗有重要意义。盐酸万古霉素综合治疗方案能有效治疗眼内炎。

Abstract:

AIM:To analyze the outcome and complication of the norvancomycin integrity treatment in bacterial endophthalmitis. METHODS: Twenty-seven patients 27 eyes were observed from July, 2009 to August, 2011. All the patients underwent corpus vitreum bacterial culture and suspecptibility. The vitreous injections of norvancomycin were performed. The treatment also included intravenous injection of norvancomycin and levofloxacin. The patients without improvement underwent vitrectomy with norvancomycin perfusion fluid after two to four days. The best-correct visual acuity, intraocular pressure, anterior chamber and vitreum changes were observed before and after operation. The data were evaluated by statistical analysis. RESULTS:Twenty-seven patients were healing well with increase of visual acuity. 56% specimens were found positive by 67% for gram-positive bacteria. Most gram-positive bacteria were susceptible to norvancomycin while the gram-negative to levofloxacin. 8 patients healed by vitreous injections and 18 patients by vitrectomy. The best correct visual acuity and symptoms were increased. CONCLUSION: The bacterial culture of vitreous could guide the clinical treatment. The norvancomycin integrated treatment is effective for bacterial endophthalmitis.