| Objective: To analyze the clinical features,treatment and prognosis of endogenous endophthalmitis caused by liver abscess.Methods:Retrospective analysis all cases of endogenous endophthalmitis caused by liver abscess in our hospital within 7 years.The data collected included age,sex,history of diabetes,initial and final visual acuity,pathogenic bacteria,course of disease,treatment and prognosis.Data Analysis with SPSS 23.0 Statistical Software.T test is used for continuous variable data and ? 2 test is used for qualitative variable data,and P < 0.05 as a significant difference standard Results: 21 eyes of 19 patients with liver abscess.The average age was 55.9 ±9.8 years old,10 males(10/19,52.6%)and 9 females(9/19,47.4%).13 cases(13/19,68.4%)were complicated with diabetes mellitus,14 cases(14/19,73.7%)of endophthalmatitis were first diagnosed in ophthalmology,5 cases(5/19,26.3%)were in hepatobiliary surgery,14 cases had fever before onset,the mean time of fever was 5.74 ±5.63 days.The mean duration of ocular symptoms before treatment was 6.84 ±3.99 days the mean duration of ocular symptoms was 5.64 ±2.50 days for the first visit to ophthalmology,and 10.20 ±5.67 days for the first time visit to non-ophthalmic departments,the t test of two independent samples was performed,and there was significant difference between the two groups(P=0.023,<0.05).The mean visual acuity of the first in the ophthalmology was 0.61 + 0.94,and 1.57 + 0.98 in the non ophthalmology patients,there was significant difference between the two groups(P=0.043,<0.05).The results of vitreous fluid culture were positive in 7 eyes(7/21,33.3%)of 21 eyes,all of them were Klebsiella pneumoniae.The final visual acuity of 7 eyes with positive results in bacteria culture were improved by-0.43 ±0.53,and the average visual acuity of 14 eyes with negative results in bacteria culture were improved by 1.28 ±1.56,the t test of two independent samples was performed,and there was significant difference between the two groups(P=0.012,<0.05).Among the 14 patients with fever,5 patients(5/14,35.7%)were positive for blood microorganism culture,all of which were KP-positive.The average visual acuity of 21 eyes was 0.93 ±1.04,and the final average best corrected visual acuity was 1.64 ±1.95 after treatment,the t test of two independent samples was performed,and there was significant difference between the two groups(P=0.047,<0.05).The average visual acuity was improved by 1.28 ±1.75 after vitrectomy,and by-0.06 ±0.73 in patients without vitrectomy,the t test of two independent samples was performed,and there was significant difference between the two groups(P=0.030,<0.05).The mean final visual acuity after vitrectomy was 2.58 ±2.03,and that in patients without vitrectomy was 0.39 ±0.86,there was significant difference between the two groups(P=0.004,<0.05).All the patients with endophthalmitis had the best corrected visual acuity(BCVA)< 3.7,and the blindness rate was 100%,the best corrected visual acuity(BCVA)after treatment was > 3.7 in 6 eyes,and the rate of blindness was 71.4%,there was significant difference between the two groups(?2=4.861,P=0.027).The effect was significant,but the best corrected visual acuity(BCVA)was less than 3.7 in 15 eyes,and the blindness rate was 71.4%,which indicated that the overall prognosis of endogenous endophthalmitis caused by liver abscess was poor.The final best corrected visual acuity(BCVA)of 6 eyes with PPV was more than 3.7,and the rate of blindness reduction was 50%.The final best corrected visual acuity(BCVA)of 9 eyes without PPV was < 3.7,there was significant difference between the two groups(?2=4.088,P=0.43)In 9 eyes treated with intravitreous injection,3 eyes(3/9,33.3%)underwent enucleation because of panophthalmitis,vitrectomy was performed in 12 eyes,of which 1 eye(1/12,8.3%)underwent enucleation because of repeated inflammation.Conclusion: The prognosis of endogenous endophthalmitis caused by liver abscess is poor,but early treatment can save some vision.The first visit to an non-ophthalmic department can delay the early diagnosis of the disease.Klebsiella pneumoniae is the leading pathogenic bacteria cause of intraocular infection.Vitrectomy combined with intravitreal antibiotic injection can improve the prognosis and reduce blindness rate compared with antibiotic therapy alone.The systematic and thorough treatment of liver abscess is of great significance in preventing the recurrence of endophthalmitis of liver abscess. |
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