眼内炎PPT医学课件

osmolality
• - rapid onset (12-24 hours of surgery) • - lack of isolated organisms by gram stain or culture • - predominance of anterior inflammation • Anterior segment infection by contiguous structures eg blebitis,
• Differential Diagnosis
• Occult retention of lens material • Toxic anterior segment syndrome • - sterile inflammation due to non-infectious, toxic substances that
keratitis
• hypopyon uveitis (eg. Behcet’s disease)
• Microbiloogical characteristics • most commonly by bacteria • Fungal infection may occur in conjunction
endophthalmitis cf scleral or limbal insicions 1,2
• 发生眼内炎频率较高是二次人工晶体植入 术 (0.2%-0.36%)
•经平坦部玻璃体切除术有较低发生率 (0.03%-
0.046%)
•其他: 穿透性角膜移植术, 小梁切除术, 青光眼引流 装置
•也曾报道发生在外眼手术 •- 斜视手术 •- 巩膜外加压 •- 胬肉切除 •- 角膜拆线
• 危险因素 • 术前准备 • - 睑缘炎 • - 结膜炎 • - 泪小管炎, 泪囊炎, 鼻泪管堵塞 • - 佩戴角膜接触镜 • - ocular prosthesis in the fellow orbit • - 糖尿病 • - immunosuppresion • Intra-op • - inadequate eyelid/conjunctival disinfection • - 手术时间长 (>60 分钟) • - 玻璃体丢失 • - inadequate draping of lids and lashes away from the surgical site
enter the AC during or after intraocular surgery
• - eg. preservatives, detergents, cleaning compounds, intraocular
solutions, with inappropriate chemical comosition, pH or
• Gram positive bacteria (94.2%)1 • Gram negative bacteria (5.9%)
• Prevention: Prophylactic antibiotics • Pre-op • - prophylactic preoperative topical antibiotics shown to reduce number of potential
Hale Waihona Puke • 危险因素 • 术后 • - 伤口渗漏或裂开 • - 不适当的埋线 • - 拆线 • - 玻璃体嵌顿 • - 存在一个滤过泡 • - 缝线脓肿
• 评估 • Differentiate PL from Hand movement VA • - major factor in decision for vitrectomy (based on endophthalmitis
• 流行病学 • 最常见的眼内炎 • 白内障手术是眼科中最常见的内眼手术，
90％的术后眼内炎发生在此种手术后 白 内障术后发生眼内炎频率相对较低: 0.08% to 0.28% (clear corneal incisions
have been a/w increased incidence of
with the use of contaminated ocular irrigating fluids
• causative organisms usually represent
bacteria from patient’s own periocular flora, introduced into the eye during surgery.
vitrectomy study)
• - no closer than 60cm, with light illumination from behind the patient • U/S evaluation if fundal view obscured • - dispersed vitreous opacities • - chorioretinal thickening • - RD or choroidal detachment • - dislocated lens material • - retained foreign bodies
• 体征 • - 前房积脓 (85%) • - media haze obscuring retinal vessels (79%) • - PL vision (26%) • - 相对性瞳孔阻滞 • - 角膜水肿, 角膜侵润 • - 前房纤维素样反应 • - 玻璃体炎, 视网膜炎, 视网膜静脉周围炎
眼内炎
分
• (1) 感染性眼内炎
• 术后
• - 急性术后眼内炎 • - 迟发性眼内炎 • - 青光眼滤过泡相关性眼内炎
• 内源性眼内炎 • 外伤后
• (2) 非感染性眼内炎
• 无菌性葡萄膜炎 • 晶状体过敏性眼内炎 • 交感性眼内炎
类
急性术后眼内炎
• 感染性眼内炎发生于内眼手后 (<6 周) • 大多数发生于术后几天至2周内 • 症状进展迅速 • - 视力模糊 (94.3%) • - 眼红 (82.1%) • - 疼痛 (74%) • - 眼睑肿胀 (34.5%) • - 眼分泌物