【摘要】 目的探讨真菌性眼内炎的主要致病因素,常见致病真菌菌种及治疗结果,为真菌性眼内炎的诊治提供参考。方法回顾分析2007年1月至2012年12月的27例真菌培养阳性的眼内炎患者(27眼)临床资料、致病因素、标本涂片的显微镜检和培养结果以及治疗过程和疗效。结果 27例眼内炎患者中外源性感染21例(77.8%),其中20例是眼部穿通伤所致,1例白内障术后感染;内源性感染6例(22.2%),3例近期使用大剂量激素,1例流产术后,1例继发于骨盆骨折,1例长期应用免疫抑制剂。27例患者进行了玻璃体涂片显微镜查菌丝,阳性率为63.0%(17/27)。27例患者共培养出8个菌属12个菌种,主要病原菌属为曲霉属11例(40.7%)、镰刀属8例(29.6%)和念珠菌属3例(11.1%)。曲霉属主要是黄曲霉6例(22.2%)和烟曲霉5例(18.5%);镰刀属主要为串珠镰刀4例(14.8%)和尖孢镰刀3例(11.1%)。25例患者接受了玻璃体切割手术、玻璃体腔注射抗真菌药物以及穿透角膜移植等一种或多种治疗措施,22例保留住眼球,3例经上述治疗无效行眼内容剜除术;2例患者因病情严重直接行眼内容剜除术。结论真菌性眼内炎主要是外源性眼内炎。眼穿通伤是外源性眼内炎最常见的致病因素,曲霉和镰刀霉是主要病原菌。大量使用激素是内源性眼内炎的主要病因。标本涂片查找菌丝和真菌培养是诊断真菌性眼内炎的有效方法。玻璃体切割手术联合玻璃体腔注射抗真菌药物是治疗真菌性眼内炎的有效方法。更多还原

【Abstract】 Objective To report the clinical features and treatment outcomes of 27 patients with fungal endophthalmitis(27eyes) over a five year period.Methods The authors retrospectively reviewed the etiology,direct smear examination,fungal culture and treatments of 27 patients with culture-proven fungal endophthalmitis at the affiliated Hospital of Medical College Qingdao University from 2007 to 2012.Results Exogenous infection was defined in 21 patients(77.8%),including 20 associated with penetrating wound,and 1 following cataract surgery.Endogenous infection was found in 6 patients(22.2%),including 3associated with recent use of high-dose steroids,1 after abortion,1 following pelvic fracture,and 1 with long-term use of immunosuppressive agents.Fungal hyphae were found in 17 smears of 27 samples(63.0%) by direct microscopic examination.The fungal strains cultured from 27 samples belonged to 8 genus and 12 species.The most common isolates were Aspergillus,Fusarium and Candida species.A.flavus(22.2%) and A.fumigatus(18.5%) were the predominant Aspergillus species.F.moniliforme(14.8%) and F.oxysporum(11.1%) were the most predominant Fusariurn species.Two eyes were eviscerated immediately due to the serious condition.Among the other 25 eyes,22(88.0%) got improvement after at least one of such treatments as intravitreal injection of antifungal agent,vitrectomy or penetrating keratoplasty(PK).Conclusions Exogenous fungal endophthalmitis is the most common type of fungal endophthalmitis in this hospital.Penetrating wound is the main cause of such infections.Microscopic examination of hyphae and fungal culture were effective for the diagnosis of fungal endophthalmitis.Aspergillus is the predominant pathogens,followed by Fusarium.Intravitreal injection of antifungal agent combined with vitrectomy is an effective treatment of fungal endophthalmitis.更多还原