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[摘要]
目的:评估房水、玻璃体液细菌和真菌培养及玻璃体腔注射万古霉素对球内异物继发化脓性眼内炎诊断和治疗的临床意义。
方法:选取2012-01/2014-09我院收治的眼球穿通伤合并球内异物急诊行眼球清创缝合+眼内注药65例为研究组,并回顾收集2011-08之前只行眼球清创缝合而未采取眼内注药的球内异物病例62例为对照组。研究组和对照组每例患者术中取房水及玻璃体液作细菌+真菌培养, 研究组术毕予玻璃体腔注射万古霉素1mg,对照组术毕不予眼内注药。
结果:对照组眼内炎发生率为16%(10例),研究组为3%(2例),两组比较有显著差异(χ2=6.32, P<0.05)。两组房水细菌培养阳性率均低,研究组为3%(2例),对照组2%(1例),两组比较无显著差异(P>0.05)。研究组玻璃体液细菌培养阳性率14%(9例),眼内炎发生率3%,对照组玻璃体液细菌培养阳性率11%(7 例),眼内炎发生率16%,两组相比有显著性差异(P<0.05)。
结论:球内异物急诊行眼内注射万古霉素可以减少化脓性细菌性眼内炎的发生率,可为二期异物取出手术争取好的手术时机及条件且术后视力预后相对较好。
[Key word]
[Abstract]
AIM:To estimate the clinical significance of the microculture of humor and vitreous and vancomycin intraocular injection in treatment of suppurative endophthalmitis associated with intraocular foreign bodies.
METHODS: Totally 65 patients with penetrating eye trauma and retained intraocular foreign bodies in emergency operation and intraocular injection from January 2012 to September 2014 were regarded as the study group, another 62 patients with penetrating eye trauma and retained intraocular foreign bodies in emergency operation without intraocular injection before August 2011 were regarded as the control group. Aqueous humor and vitreous humor were taken from each patient of the study group and the control group for bacteria and fungus cultivation. The study group was treated with 1mg vancomycin intraocular injection after operation, while the control group was not.
RESULTS: The incidence of endophthalmitis in the control group was 16%(10 cases), while in the study group was 3%(2 cases), with significant difference between two groups(x2=6.32, P<0.05). The aqueous humor germiculture in both groups was in low positive rates, the study group was 3%(2 cases)and the control group was 2%(1 case), with no difference between two groups(P>0.05). The positive rate of vitreous humor germiculture in study group was 14%(9 cases), and the incidence of endophthalmitis was 3%. The positive rate of vitreous humor germiculture in control group was 11%(7 cases)and the incidence of endophthalmitis was 16%, with significant differences between two groups(P<0.05).
CONCLUSION: Intraocular foreign bodies treated with emergency operation and vancomycin intraocular injections can decrease the incidence of suppurative endophthalmitis and have a good vision prognosis for the second stage of operation.
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