| PURPOSE: To evaluate the efficacy in the treatment of Fungalendophthalmitis by Vitreous cavity drug injection combined with vitrectomy.METHODS: The8cases of fungal endophthalmitis treated by Vitreouscavity drug injection and vitrectomy were retrospectively analyzed,Hospitalized in the Eye Hospital of the Second Hospital of Jilin Universityfrom January2010to January2012.RESULTS:(1) pathogenesis:6cases of fungal inflammation caused byClear trauma, including three cases by plant injury and three cases by ironinjury. No obvious incentive to one patient, another occurred fungalendophthalmitis after Cataract surgery.(2) Age of onset: In the8patients, theoldest is74years old，and the youngest is9-year-old. Average age is37.5years.Two cases of children are under the age of10. Two cases is between20and40years. Three cases are between40and60years. One case is Over60years.This shows that the fungal inflammation in patients with mostly middle-aged,Followed by children and young people.(3) Time of onset and pathogendetection: in this group of patients, longest time of onset up to three months,The shortest onset time is two days, An average is29.3days. Aqueous humoror vitreous cavity fluid smears were found fungal hyphae in8patients. Smearpositive rate is100%, Cultures were negative.(4) Surgical treatment results: inthis group of8patients, six cases of patients underwent intravitreal druginjection and vitrectomy. One patient underwent intravitreal injection combinedwith anterior vitrectomy. No significant improvement in one case after a routinevitreous cavity injection, transferred to a higher level hospital.2eyes withsilicone oil tamponade surgery.1eye was filled with C3F8.3eyes Simplevitrectomy surgery.We continue to apply antifungal agents1month after surgery, during the treatment blood routine, liver function and renal werenormal.(5) Preoperative and postoperative visual acuity change: Preoperativevisual acuity: Vision0.1in one case，0.1more is zero, CF/three eyes，HM/two eyes，one case had light perception, No light perception in1case. After amonth of treatment vision: Vision0.1in one case，CF/four eyes, HM/threeeyes, Visual acuity improved in five eyes, Unchanged in2cases,1cases ofvision loss. Anterior chamber: before surgery, four cases of hypopyon, withouthypopyon after surgery. Vitreous cavity conditions: the vitreous cavity of8patients were seen the white wire network-like or mass opacity before surgery.Through the vitreous cavity injection or combination with vitreous excision in8patients, the vitreous cavity of7patients improved gradually. The vitreouscavity in1patient underwent two injections, a week later the vitreous cavityopacity no significant improvement, transferred to higher level hospital. Apatient underwent intravitreal injection, combined with anterior vitrectomy,3days after surgery the anterior vitreous still saw a small amount of flocculentexudate, followed by local administration and systemic administration ofantifungal treatment, after one month no exudate.(6) Postoperative follow-upresults: Postoperative follow-up after a month to six months, there are one casefilled with inert gas seeing retinal detachment after1month, there are one casefilled with Silicone oil seeing retinal detachment after3months. One patientwas in stable condition after only intravitreal injection, repeated illness of oneweek after discharge, re-admitted underwent vitrectomy.CONCLUSIONS:(1) Fungal intraocular inflammation is a high-blinding eye disease and poor prognosis.(2) Penetrating eye injuries are themain factor leading to fungal eye inflammation.(3) Positive fungal smear asthe primary diagnostic criteria of fungal eye inflammation.(4) Voriconazole forfungal strong antimicrobial effect, the high drug concentration in the eye, andside effects can be used as the first choice for systemic administration.(5) Intravitreal injection of Amphotericin B liposome combined vitrectomy is aneffective means of treatment of fungal eye inflammation. |
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