目的：探讨临床分离的铜绿假单胞菌感染所致眼内炎的临床特点及对常用抗菌药物耐药情况，为临床合理使用抗菌药物提供治疗依据。方法：回顾2013年1月—2024年12月在中山大学中山眼科中心确诊感染铜绿假单胞菌的眼内炎患者资料，记录并分析患者临床特点及对常用抗菌药物耐药情况。结果：44例确诊感染铜绿假单胞菌的眼内炎患者，2例患者采取保守治疗，42例患者接受外科手术治疗。其中13例患者行玻璃体腔内注射抗菌药物及玻璃体切割术，10例患者行玻璃体切割术，19例患者行眼球摘除术。治疗后，1例患者视力达到20/400，3例患者视力为指数视力（finger count, FC），9例患者视力为手动视力（hand move, HM），5例患者视力为光感（light perception, LP），26例患者视力无光感（no light perception, NLP）。体外药敏试验显示，铜绿假单胞菌对阿米卡星、美罗培南、妥布霉素敏感度为100.0%；对庆大霉素敏感度为97.5%；对左氧氟沙星、环丙沙星敏感度为95.0%；对头孢吡肟、亚胺培南敏感度为80.0%；对头孢他啶、氧氟沙星敏感度为75.0%；对氯霉素、头孢唑啉、头孢呋辛、头孢曲松及复方磺胺甲噁唑的敏感度均为0%。结论：铜绿假单胞菌性眼内炎患者的视力预后较差，眼球摘除率居高不下。铜绿假单胞菌对阿米卡星、美罗培南、妥布霉素表现出较好的敏感性。
Objective: To explore the clinical characteristics and antibiotic resistance patterns of endophthalmitis induced by Pseudomonas aeruginosa at our hospital from January 2013 to December 2024, with the aim of providing evidence to support the rational clinical use of antimicrobial agents. Methods: A retrospective analysis was conducted on patients diagnosed with Pseudomonas aeruginosa endophthalmitis at Zhongshan Ophthalmic Center, Sun Yat-sen University, during the period from January 2013 to December 2024. Clinical features and antibiotic resistance profiles of the patients were documented and analyzed. Results: Among the 44 patients, 2 received conservative treatment. The remaining 42 patients underwent surgical intervention: 13 patients received intravitreal antibiotic injection combined with vitrectomy, 10 patients underwent vitrectomy alone, and 19 patients required enucleation. Post-treatment visual outcomes were as follows: 1 patient achieving 20/400 vision, 3 patients had with finger count (FC) vision, 9 with hand move (HM), 5 patients with light perception (LP), and 26 patients with no light perception (NLP). In vitro drug susceptibility tests revealed that Pseudomonas aeruginosa was 100.0% sensitive to amikacin, meropenem and tobramycin; 97.5% sensitive to gentamicin; 95.0% sensitive to levofloxacin and ciprofloxacin; 80.0% sensitive to cefepime and imipenem; 75.0% sensitive to ceftazidime and ofloxacin; and 0% sensitive to chloramphenicol, cefazolin, cefuroxime, ceftriaxone and cotrimoxazole. Conclusions: The visual prognosis of patients with Pseudomonas aeruginosa endophthalmitis remains poor, with a high rate of enucleation. The pathogen demonstrated favorable susceptibility to amikacin, meropenem, and tobramycin.
目的：分析23G/25G微创玻璃体切割术后发生眼内炎的危险因素。方法：回顾性分析2014年6月—2023年5月于中国人民解放军中部战区总医院行微创玻璃体切割术后，临床诊断为眼内炎患者(开放性眼外伤患者除外)的临床特征。结果：纳入8 955例行微创玻璃体切割术患者，其中11例微创玻璃体切割术后患眼发生眼内炎，发生率为0.12％。平均年龄(60.8±7.6)岁。11例其中，5例(45.4%)患者合并糖尿病；原发眼疾构成情况：黄斑疾病7例(63.6%)、增殖期糖尿病性视网膜病变继发玻璃体积血2例(18.2%)，视网膜裂孔继发玻璃体积血1例(9.1%)、视网膜脱离1例(9.1%)；术中联合行白内障手术3例(27.3 %)；术毕8例(72.7%)患眼玻璃体腔填充无菌空气，3例(27.3%)填充平衡盐溶液，术毕所有患者均未缝合巩膜穿刺切口；术后低眼压3例(27.3 %)。术后发生眼内炎的时间为(2.8±1.1)d。11例患者经过局部和全身抗感染治疗后炎症控制不佳，均再次行玻璃体切割术联合术中配置万古霉素液灌注，其中9例术毕玻璃体腔填充硅油，术后所有眼内炎得到控制，10例(91.0%)患者最终矫正视力有所提高。结论：微创玻璃体切割术后，免缝合的巩膜切口可能是病原微生物侵入眼内导致眼内炎的潜在途径。尤其要重视黄斑手术中玻璃体不全切除引起巩膜切口处发生玻璃体束综合征可能是术后发生眼内炎的危险因素之一。
Objective: To analyze risk factors for endophthalmitis occurred after 23G/25G minimally invasive vitrectomy. Methods: Retrospective analysis of the clinical characteristics of patients with endophthalmitis (except patients with open eye trauma) after minimally invasive vitrectomy in General Hospital of Central Theater Command(Wuhan,430064) from June 2014 to May 2023. Results: This study included 8,955 patients, of which 11 cases occurred endophthalmitis after minimally invasive vitrectomy, with an incidence rate of 0.12%. The average age was (60.8±7.6) years, and 5 patients (45.4%) were complicated with diabetes; The composition of primary eye diseases: 7 cases (63.6%) of macular disease, 2 cases (18.2%) of vitreous hemorrhage secondary to proliferative diabetic retinopathy and 1 case (9.1%) vitreous hemorrhage secondary to retinal fissure, 1 case (9.1%) of retinal detachment; During the operation, 3 cases (27.3%) underwent combined cataract surgery; After the operation, 8 cases (72.7%) were filled with sterile air in the vitreous cavity of affected eye, the other 3 cases (27.3%) were filled with equilibrium liquid,and sclera puncture incision was not sutured in all patients; 3 cases (27.3%) had low intraocular pressure after operation. The time for postoperative endophthalmitis to occur after operation was 2.8±1.1day. 11 patients had poor inflammation control after local and systemic anti-inflammatory treatments, and all underwent vitrectomy combined with intraoperative injection of vancomycin solution. Among them, 9 patients were filled with silicone oil in the vitreous cavity after the surgery. After the operation, all the endophthalmitis were controlled and final corrected visual acuity of 10 patients improved. Conclusions: Minimally invasive vitrectomy and suture-free scleral incision may be a potential way for pathogenic microorganisms to invade the eye and cause endophthalmitis. Particular attention should be paid to the ‘Vitreous Wick Syndrome’ at the scleral incision caused by incomplete vitrectomy in macular surgery, which may be one of the risk factors for postoperative endophthalmitis.
蜡样芽孢杆菌性眼内炎（Bacillus cereus endophthalmitis）是由蜡样芽孢杆菌经外源性/内源性途径感染引发的严重眼部疾病，以暴发性进展、预后不良为特征。典型临床表现为眼组织咖啡样溶解、前房咖啡色积脓及视网膜不可逆损伤，即使采用万古霉素抗感染联合玻璃体手术治疗，仍有75%～91%的患者难以恢复有效视力，约30%的患者因眼球内容物剜除或眼球摘除而致残。当前临床诊疗仍面临双重瓶颈：其一，蜡样芽孢杆菌致病机制复杂，核心因素尚未明确；其二，玻璃体切割术联合万古霉素治疗虽可延缓病程，但多数患者预后仍较差，诊疗策略有待优化。本文系统综述蜡样芽孢杆菌性眼内炎分子致病机制研究进展，基于溶细胞毒素[溶血素BL（hemolysin BL, HBL）/非溶血性肠毒素（non-hemolytic enterotoxin, NHE）/细胞毒素K（cytotoxin K, CytK）/溶血素(hemolysin）]的膜破坏作用和炎症反应、磷脂酶类的侵袭性与超氧化物歧化酶的免疫逃逸、菌体结构组分（鞭毛、菌毛、S层蛋白）致病效应以及宿主免疫应答[Toll样受体（Toll-like receptor, TLR）/NLRP3炎症小体（NLRP3 inflammasome）]失衡四个方面，整合分析国内外基础研究数据，以期为该病致病机制深度解析、靶向治疗策略探讨和转化医学前景展望等提供理论框架。
Bacillus cereus endophthalmitis is a severe ocular infection characterized by rapid progression and a poor prognosis, which can originate from either exogenous or endogenous sources. Clinically, it manifests as coffee-colored hemorrhages in ocular tissues, coffee-colored hypopyon in the anterior chamber, and irreversible retinal damage. Despite the implementation of infection control measures, such as vancomycin treatment and vitrectomy, 75%–91% of patients are unable to regain functional vision. Moreover, approximately 30% of patients require enucleation or removal of ocular contents, resulting in significant disability. The current clinical diagnosis and treatment of Bacillus cereus infections are confronted with two major challenges. Firstly, the pathogenic mechanisms are complex, and key contributing factors remain unidentified. Secondly, although vitrectomy combined with vancomycin can slow down the progression of the disease, the prognosis for most patients remains dismal, highlighting the urgent need for improved diagnostic and treatment strategies. This review conducts a systematic examination of the molecular pathogenic mechanisms of B. cereus endophthalmitis, integrating findings from both domestic and international studies. Specifically, this paper offers a comprehensive and systematic review of the latest research on the molecular pathogenic mechanisms of Bacillus cereus endophthalmitis, with a focus on four main areas: the membrane-damaging effects and inflammatory responses induced by cytolytic toxins (HBL/NHE/CytK/hemolysin); the invasiveness of phospholipases and immune evasion by superoxide dismutase; the pathogenic effects of bacterial structural components (flagella, pili, S-layer proteins); the imbalance in host immune responses (TLR receptors/NLRP3 inflammasome). By integrating and analyzing research data from both domestic and international, this review aims to establish a theoretical framework. This framework is intended to enhance in-depth understanding of the disease’s pathogenic mechanisms, facilitate the exploration of targeted therapeutic strategies, and offer insights into the future prospects of translational medicine.
内源性真菌性眼内炎(endogenous fungal endophtalmitis, EFE)是最具破坏性的眼部感染之一，在临床上较少见。如诊断和治疗不及时，可严重损害患者视力，甚至需摘除眼球。由于EFE发病隐匿，病程较长，病原学涂片和培养阳性率较低，早期临床症状与葡萄膜炎相似，极易被误诊和漏诊，延误治疗时机。EFE最常见的感染灶来源为肝脏、肺、尿路、脑膜炎、胃肠道、心内膜以及骨髓。文章报道了一例腰椎感染致双眼内源性念珠菌性眼内炎的男性患者，66岁，因“右眼视力下降1周”首诊于眼科，专科检查见右眼玻璃体炎性混浊，初诊为右眼葡萄膜炎，予抗炎等治疗症状无好转，右眼视力持续下降，右眼前房穿刺抽液送检提示：热带念珠菌感染，之后左眼视力也逐渐下降，加之患者近期于骨科住院，术中腰椎间盘退变的纤维软骨组织DNA-病原微生物宏基因组检测结果示热带念珠菌，考虑双眼EFE，予全身及局部使用抗真菌药物联合双眼玻璃体切割手术，治疗后患者视力恢复良好，随访1年无复发。该病例及相关文献回顾，有助于加深临床医生对此类疾病的认识，为今后临床诊疗提供一定思路，也起到一定警示作用。
Fungal endophthalmitis is one of the most destructive eye infections and is relatively rare in clinical practice.If not diagnosed and treated promptly, it can severely damage vision and even lead to enucleation.Due to its insidious onset, long course, low positive rates in smears and cultures, and early clinical symptoms similar to uveitis, it is prone to misdiagnosis and missed diagnosis, leading to delayed treatment. A review of the literature indicates that the most common sources of EFE infection are the liver, lung, urinary tract, meningitis, gastrointestinal tract, endocarditis and osteomyelitis.In this paper, we report a case of lumbar spine infection causing bilateral candidal endophthalmitis in a 66-year-old male patient.He initially presented to the ophthalmology department of our hospital with a one-week history of decreased vision in the right eye, specialized examination revealed inflammatory opacity in the vitreous of the right eye, initially diagnosed as uveitis and treated with anti-inflammatory therapy without improvement.As the vision in the right eye continued to decline, aqueous humor aspiration from the anterior chamber of the right eye indicated infection with tropical Candida.Subsequently, the vision in the left eye also gradually decreased.Considering the recent hospitalization in the orthopedic department for lumbar disc degeneration, metagenomics analysis of fibrous cartilage tissue DNA during surgery detected tropical Candida, suggesting bilateral endogenous fungal endophthalmitis,The patient was treated with systemic and local antifungal medications in combination with bilateral vitrectomy surgery.After treatment, the vision recovered well, and there was no recurrence during a one-year follow-up.The objective of this thesis is to deepen the understanding of clinicians on this type of disease by reporting this case and reviewing relevant literature, providing some insights for future clinical diagnosis and treatment, and serving as a warning.
真菌性眼内炎是临床上少见的眼内感染疾病。因为其诊断延迟和抗真菌药物的有效性有限，因此真菌性眼内炎常常导致视力严重损害。按照感染性途径，真菌性眼内炎包括内源性和外源性，其中外源性眼内炎常见，进展较快，眼部手术术后感染是常见原因之一。小梁切除术是抗青光眼滤过性手术，是目前手术治疗青光眼的有效方法之一。滤过泡相关性眼内炎是其并发症之一，对患者视功能的损害尤为严重。本文通过回顾1例滤过泡相关性真菌性眼内炎患者的临床病例资料，讨论及分析滤过泡相关性的真菌性眼内炎的危险因素及诊治方法。
Fungal endophthalmitis is a disease which is a rare kind of interocular infection in clinic. Fungal endophthalmitis often results in severe visual impairment because of delayed diagnosis and limited effectiveness of antifungal drugs.Fungal endophthalmitis includes endogenous and exogenous endophthalmitis which is common and progresses rapidly. Postoperative infection is one of the common causes of fungal endophthalmitis. Trabeculectomy is an anti-glaucoma filtering operation, and it is one of the effective methods for glaucoma surgery at present. Glaucoma-filtering bleb infection is one of the complications of trabeculectomy, which can lead to severe visual impairment.In this article, we analyzed and discussed the risk factors, diagnosis and treatment methods about the filtering bleb-associated fungal endophthalmitis.
目的：分析肺炎克雷伯菌导致内源性眼内炎在糖尿病患者中的临床特征，总结治疗经验及评估其预后。方法：回顾性病例分析2019年1月至2022年3月期间就诊于山东中医药大学附属眼科医院的肺炎克雷伯菌导致的内源性眼内炎糖尿病患者7例(8眼)。分析其年龄、性别、感染灶来源、就诊时间、治疗前后视力、眼压、裂隙灯检查、眼底检查、眼科B超、治疗方式、感染控制及复发情况。结果：7例患者年龄(63±17.6)岁。男性5例(71.4%)，女性2例(28.6%)。术后7眼(87.5%)视力NLP，1眼(12.5%)LogMAR视力0.2。视力与患者就诊时间及就诊时视力有关。6例(85.7%)就诊前发热。8眼(100%)结膜混合充血，1眼(12.5%)前房积脓。7眼(87.5%)行玻璃体切割术联合玻璃体腔注药术，1眼(12.5%)行单纯玻璃体腔注药术。8眼感染均控制，无眼球摘除。随访期间眼压正常，无感染复发。结论：肺炎克雷伯菌是内源性眼内炎的主要致病菌，易在糖尿病人群中发生。发病迅速进展快，早期临床表现不典型易被误诊，其预后和病程的长短及治疗的时机密切相关，尽早地治疗可挽回部分视力。
Objective: To analyze the clinical characteristics of endogenous endophthalmitis caused by Klebsiella pneumoniae in diabetic patients, and summarize the treatment experience and evaluate its prognosis. Methods: A retrospective case analysis was performed on 7 patients (8 eyes) with endogenous endophthalmitis caused by Klebsiella pneumoniae, who were admitted to the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2019 to August 2022. The age, gender, origin of infection, time of treatment, visual acuity before and after treatment, intraocular pressure, slit lamp examination, fundus examination, ophthalmic B-mode ultrasound, treatment methods, infection control and recurrence were analyzed. Results: The mean age of the seven patients was (63±17.6). There were five males (71.4%) and 2 females (28.6%). Postoperative visual acuity was NLP in seven eyes (87.5%) and LogMAR visual acuity was 0.2 in one eye (12.5%). Visual acuity was related to the patient’s visit time and the visual acuity at visit. Six cases (85.7%) had fever before treatment. Fever was a risk factor for Klebsiella pneumoniae endophthalmitis infection. Eight eyes (100%) had mixed conjunctival congestion, and one eye (12.5%) had abscess in the anterior chamber. Seven eyes (87.5%) underwent vitrectomy combined with intravitreal drug injection, and one eye (12.5%) underwent intravitreal drug injection alone. Infections were controlled in all eight eyes without enucleation. Intraocular pressure was normal during the follow-up period, and there was no infection recurrence. Conclusions: Klebsiella pneumoniae is the main pathogen of endogenous endophthalmitis and is prone to occur in people with diabetes. The onset of the disease progresses rapidly. The early clinical manifestations are not typical, and the prognosis is closely related to the duration of the disease and the timing of treatment. Early treatment can restore some vision.
目的：分析玻璃体腔注射术后眼内炎的发生并总结原因，旨在进一步提高手术安全性。方法：回顾性分析中国人民解放军总医院第六医学中心2010年9月至2019年11月行玻璃体腔注射术的421例患者(973眼)的术后1 d、1周、1个月的随访资料。归纳注射药物种类、注射病因、患者全身病史，总结术后眼内炎的发生及治疗情况。结果：玻璃体腔注射术安全性高，但严重并发症眼内炎(0.41%)仍偶有发生。4例眼内炎患者中2例为Irvine-Gass综合征患者行曲安奈德玻璃体腔注射后，1例为视网膜中央静脉阻塞患者行曲安奈德玻璃体腔注射后，1例为中心性渗出性视网膜脉络膜病变患者行雷珠单抗玻璃体腔注射后。其中曲安奈德引起的眼内炎(1.99%)明显高于抗血管内皮生长因子(vascular endothelial growth factor，VEGF)药物引起的眼内炎(0.12%)。结论：严格按照操作指南操作，当针对高血压老年群体尤其是Irvine-Gass综合征患者玻璃体腔注射曲安奈德时尤其防范眼内炎的发生。
Objective: To analyze the incidence and causes of endophthalmitis after intravitreal injection and to further improve the safety of the surgery. Methods: The follow-up data of 973 eyes of 421 patients who received intravitreal injection in our hospital in the past 9 years at 1 day, 1 week and 1 month were retrospectively analyzed.The types of injected drugs, the cause of injection and systemic history were summarized, and the occurrence and treatment of postoperative endophthalmitis were summarized. Results: The intravitreal injections were safe.However, the severe complication of endophthalmitis (0.41%) occurred occasionally. Among these 4 patients with endophthalmitis, 2 patients were intravitreal injected triamcinolone acetonide because of Irvine-Gass syndrome;1 patient accepted intravitreal injection by Ranibizumab because of central retinal vein occlusion; 1 patient accepted intravitreal injection by Ranibizumab because of central exudative chorioretinopathy. The incidence of endophthalmitis (1.99%) after intravitreal injection of triamcinolone acetonide was higher than that of anti-vascular endothelial growth factor (VEGF) agents (0.12%). Conclusion: The clinical operating guideline of intravitreal injection should be followed strictly. Furthermore, the elderly people with hypertension diagnosed of Irvine-Gass syndrome have a higher risk of endophthalmitis after intravitreal injection of triamcinolone acetonide than others and should be paid more important attention.
临床上内源性真菌性眼内炎比较少见，其早期临床表现因类似于葡萄膜炎等常见眼病常常被误诊。武汉爱尔眼科医院汉口医院收治了1例49岁女性患者，首诊为葡萄膜炎，后前房穿刺送检确诊为内源性念珠菌性眼内炎。
Endogenous fungal endophthalmitis is easy to be misdiagnosed because it is quite rare and early clinical features resembling uveitis. A 48-year-old female patient was admitted to Wuhan Aier Eye Hospital Hankou Hospital, her first diagnosis was uveitis, and the posterior anterior chamber puncture was confirmed as endogenous Candida endophthalmitis.
