| Posttraumatic infectious endophthalmitis is the most serious complications of ophthalmic trauma.The overall frequency estimated by large statistic data is approximately from 3.3% to 17%,but is reported to be 30% after rural penetrating trauma. Posttraumatic infectious endophthalmitis differs from postoperative and endogenous endophthalmitis both in its causative microorganisms and in its poorer visual prognosis. The poorer visual prognosis with posttraumatic endophthalmitis is probably attributable to the combination of ocular injury, the different spectrum of infecting microbes and a delay in treatment. The rapid initiation of therapy is the key to save globe and maintain certain visual acuity after posttraumatic infectious endophthalmitis.In order to evaluate the effect of the combination of vitrectomy and cataract surgery with corticosteroids used in the treatment of severe endophthalmitis, to evaluate the effect of surgical time in final visual acuity and to explore what kind of therapeutic methods should be choosed to treat various intensity posttraumatic infectiouis endophthalmitis,we retrospectively analysed 41 eyes diagnosed as posttraumatic infectiouis endophthalmitis from our hospital between April 2002 to April 2004.35 eyes are male while 6 eyes are female. All patients were followed up for 3 to 6 months.Among tramatic cause ,foreign body is the most common cause (43.9%). Subconjunctival,systemic and topical antibioticswith corticosteroids were used in the treatment of five minor cases whose aqueous humor and vitreous were turbid but the red reflect light of fundus could be seen and visual acuity were above light perception. The combination of vitrectomy and lens surgery was used in the treatment of thirty moderate and severe cases. Enucleation with hydroxyapatite implantation was used in the treatment of six patients whose eyeballs had serious ruptured and were unable to be repaired. Finally,34 patients' infectious syndrom were controlled and achieved better final visual acuity.We also found that the patients treated with vitrectomy in 3 days achieved better visual acuity than those above 3 days.Because blood-ocular barrier may not be intact in an inflamed eye,subconjunctival, systemic and topical administration of antibiotics can get an therapeutic concentrations within the eye.we don't recommend using intravitreal injection in minor cases because it has too many complications.To reduce the destructive effect of the significantinflammation that coexists with infection in endophthalmitis,we recommend using systemic, topical and subconjunctival,corti--costeroids in combination with antibiotics, provided that no co--ntraindications exist. Corticosteroids can reduce the intr-aocular inflammatory process and secondary complications associated with microbial endophthalmitis,such as retinal detachment. Many experiments found that the use of intravitreal dexamethasone (400 mg) had no potential retinal toxicity,and it is a good method to treat the patients with contraindications ininitial stage of endophthalmitis,without any side effect.Vitrectomy has the potential advantages of removing theinfecting organism and associated toxins, removing vitreous membranes that could lead to retinal detachment and improvingintraocular distribution of antibiotics.So vitrectomy is necessary in severe cases of endophthalmitis. Extracting cataract whichcaused by tramau or opacity due to severe infections will help to increase the acuity and the field of operation.In addition, lensectomy can accelerate the associated toxins and inflammatory substances removing from eye through trabecular reticulum. Therefore,we think that vitrectomy with lens surgery is the most effective method in the treatment of severe posttraumatic endophthamitis,and recommend operator to plus scleral encircling to prevent tractional detachment of retina. Adding medicine in persusate to take place of intravitreal injection will help to avoid medicine concentration exceeding within eye i... |
PDF Full Text Request