儿童外伤性眼内炎的临床疗效分析

Analysis of clinical effect on post-traumatic endophthalmitis in children

摘要:

目的：探讨儿童外伤性眼内炎的治疗效果。

方法：回顾性研究2～11岁儿童确诊为外伤性眼内炎24例24眼的治疗方法及结果。所有患儿入院后立即行患眼的玻璃体腔内注药(万古霉素1mg/0.1mL+头孢他啶2.25mg/0.1mL+地塞米松0.4mg/0.1mL)，第2d ，23例重症者行玻璃体切除+晶状体切除术，充填硅油者10例、无菌空气者8例、C₃F₈者3例、灌注液者2例。1例轻症者72h后再次注射。

结果：术后随访6～78mo，所有病例炎症控制，4例眼球萎缩(3例硅油眼)。7例硅油眼已取出硅油并植入IOL。BCVA：<0.02者12例， 0.02～0.1者4例，0.15～0.3者4例，0.5～1.0者4例。16例(70%)较入院视力提高，4例(17%)不变，3例(13%)下降，1例不配合。

结论：及时行玻璃体腔内注射广谱抗生素、玻璃体切除术能改善儿童外伤性眼内炎的预后。

Abstract:

AIM: To analyze the outcome of treating post-traumatic endophthalmitis in children.

METHODS: Twenty-four 2～11 year-old children(24 eyes)with post-traumatic endophthalmitis that presented to our hospital from June 2006 to Feburary 2014 were retrospectively analyzed. All cases were performed intravitreal injection of vancomycin(1mg/0.1mL)and ceftazidime(2.25mg/0.1mL)and dexamethasone(0.4mg/0.1mL)immediately after being identified. The second day after injection, 23 eyes were received lensectomy and vitrectomy with silicone oil(n=10)or C₃F₈(n=3)or clean air(n=8)or irrigating solution(n=2)tamponade. Only one eye was reinjected at 72h after the first injection. The visual outcomes were evaluated.

RESULTS: After follow-up 6～78mo, the inflammation of all cases were controled, 4 cases of eyeball atrophy(3 cases of silicone oil eye). Other 7 silicone oil filled eyes were received silicone oic extraction and IOL implantation. Twelve eyes presented with visual acuity of lower than 0.02, 4 eyes achieved 0.02～0.1, 4 eyes were 0.15～0.3,only 4 eyes reached 0.5～1.0. The final visual acuity improved in 16 eyes(70%), remained unchanged in 4 eyes(17%)and decreased in 3 eyes(13%). One case did not fit.

CONCLUSION: Early diagnosis of endophthalmitis in open-globe injury, intravitreal injection of antibiotics and vitrectomy can salvage more than a half of injuried eyes in children.