眼内炎模板的教学交流.pptxVIP

眼 内 炎;分 类;急 性 术 后 眼 内 炎;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;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 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;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 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 ;Differential Diagnosis Occult retention of lens material Toxic anterior segment syndrome - sterile inflammation due to non-infectious, toxic substances that enter the AC during or after intraocular surgery - eg. preservatives, detergents, cleaning compounds, intraocular solutions, with inappropriate chemical comosition, pH or 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, keratitis hypopyon uveitis (eg. Behcet’s disease);Microbiloogical characteristics most commonly by bacteria Fungal infection may occur in conjunction with the use of contaminated ocular irrigating fluids causative organisms usually represent ba