| Objective To discuss the cause of endophthalmitis and evaluate the effect of vitrectomy combined drug treatment on endophthalmitis. To observe the changes in visual acuity and complications after vitrectomy.Methods We retrospectively analyzed records of 51 cases(51 eyes) of endophthalmitis from January 2001 to January 2010 , 40 males, 11 females,27 right eyes, 24 left eyes. The ages of patients ranged from 5 to 61 years old (mean 38.6 years). All the patients underwent pars plana vitrectomy. Preoperative examination:first, use the slit-lamp-microscopy to focus if the peripheral retina or ora serrata has lesions or foreign bodies, etc..Second,undergo ophthalmoscopy examinations: to use the direct ophthalmoscopy to go thorough observation of vitreous opacity according to location. Third,use the indirect ophthalmoscope to find out that wether it has retinal hemorrhage, vitreous proliferative traction or not, and the degree of angiogenesis, the shape of uplift, the location and size of the hole, the location and size of foreign bodys in the eyes with trauma with particularly attention. Forth,B-scan is mainly used for inspection: vitreous opacity, position, with or without foreign body, membrane, cable, retina with or without holes, uplift, hyperplasia, choroidal detachment, tears, etc.. Fifth, visual function Visual acuity, corrected visual acuity, pupil of the indirect light reflex. Sixth, X films, CT for eyes or magnetic resonance imaging: open-globe injuries or suspected with intraocular foreign body can do orbital and lateral X-chip. firstly, in order to rule out the existence of a large metallic foreign body, coronal or sagittal CT scanning of orbital may exclude smaller or non-metallic foreign body. Besides these two ways to rule out suspected small non-magnetic foreign bodies we can make use of cranial magnetic resonance imaging (MRI). Ferromagnetic implants in patients is the contraindications to MRI. If the treatment for endophthalmitis was ineffective with a large number of broad-spectrum antibiotics, then underwent the vitrectomy. Patients who can collaborate are anesthetized with local infiltration of 2% lidocaine, or the ball ciliary ganglion block anesthesia. If the patients can not collaborate with surgery, they will be used the general anesthesia. Surgery model is the conventional pars plana vitrectomy with 3 channels. Postoperative follow-up ranged from 4 to 36 months (mean 24.1 months ).Results The results showed that penetrating eye injury in 49 patients of 51 cases of patients is the most important reason for endophthalmitis, accounting for 96.1% of cases in this group. Penetrating injuries with intraocular foreign body are 23 cases, accounting for 46.9%. 9 cases of children are in the 5-8 years old group, accounting for 18.4% of penetrating eye injuries, including disposable syringe needle-stick injuries for 4 cases, wire stabbed for 2 cases, plant stalks for 2 cases, bamboo chopsticks for 1 case. Endogenous endophthalmitis for 2 cases, accounting for 3.9% of cases in this group, including 1 case of bacterial endocarditis, 1 case of diabetic foot infection. 19 cases of vitreous smear-positive detection rate account for 37.3% of 51 patients. 21 cases of culture results are positive, the detection rate is 41.2%. 15 cases of bacterial culture results are positive, including 6 cases of Staphylococcus epidermidis, 4 cases of Staphylococcus aureus, 2 cases of hemolytic streptococcus, 1 case of Staphylococcus Neisseria, 1 case of Alcaligenes faecalis, 1 case of Pseudomonas aeruginosa. Fungi in 6 patients, including 2 cases of Aspergillus fumigatus, 1 case of Candida albicans, 2 cases of yeast-like fungi , 1 case of Fusarium solani. Among the detected cases, the rate which G+ bacteria are sensitive to vancomycin is 100.0%, the rate sensitivity to ofloxacin is 80.0%, the rate which G- bacteria is sensitive to ceftazidime is 66.7%, fluconazole in general has a strong inhibitory effect on the fungi. The method of vitrectomy combined with systemic and local application of drug therapy to the group of 51 patients improved visual acuity. The method of vitrectomy with tamponade was used in 19 cases of intraoperative retinal breaks and retinal detachment of all the 32 cases of retinal surgery, and silicone oil tamponade in 15 cases; while C3F8 was filled in 4 cases. All the patients continued postoperative therapy for 1mo. Postoperative follow-up ranged from 4 to 36 months. One case of retinal detachment occurred 4mo later, we used vitrectomy and silicone oil filling again; two patients'retinal detachment occurs when they were reviewed 5mo later, one case underwent vitrectomy with silicone oil, the other patients refused to. 39 patients of 51 patients had been improved visual acuity after surgery, accounting for 78.0%, unchanged for 8 cases, 16.0%, down 3 patients, accounting for 6.0%. Evaluation criteria for the treatment is postoperative visual acuity> 0.05 as the literacy standards. It shows that the surgery effection correlates with operative time. There was anterior chamber inflammatory exudates (17eyes) 2 to 7 days later, temporary intraocular pressure elevation (14 eyes), but when inflammation subsided after treatment and the water cycle recoveried, it could return to normal intraocular pressure. After 0.5-1mo vitreous hemorrhage (5 eyes). 2 eyes had retinal detachment 4-5mo later, underwent vitrectomy again and silicone oil filling, a reviewer in 1 case was found that the recurrence of retinal detachment 5 months later, the patient refused to surgery, then the eye shrunk 12mo later. Cataracts of 2 eyes underwent cataract extraction, and intraocular lens implantation 4-6mo later.Conclusion (1) penetrating injury is the main reason of endophthalmitis. (2) G positive bacteria is the most common pathogenic of bacterial endophthalmitis. (3) In this group, the rate which G+ bacteria are sensitive to vancomycin is 100.0%, the rate which G- bacteria are sensitive to ceftazidime is 66.7%, fluconazole on the fungi in general have a strong inhibitory effect. (4) vitrectomy is the most effective means for the treatment of endophthalmitis. (5)chance for surgery is significantly associated with the effection of operation. |
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