眼內炎之眼球內抗生素療法

Intra-Ocular Antibiotic Treatment in Endophthalmitis

王惠珠(Hwei-Zu Wang)

《中華民國眼科醫學會會刊》 18卷 (1979/05) Pp. 85-93

https://doi.org/10.30048/ACTASOS.197905.0016

摘要

民國64年1月至66年10月間共有穿孔性眼外傷住院病人105人（108眼），其中77眼爲新鮮病例，另31眼於入院時已有眼內炎症狀。眼內炎之處理分為預防性及治療性兩種。預防性者乃77眼新鮮病例中，39眼做抗生素之眼球內注射，38眼以傳統方法處理。結果前者續發眼內炎者僅一眼，後者則有7眼。治療性者乃42眼眼內炎中，22眼接受抗生素之眼球內注射，20眼以傳統方法治療。結果前者保持有用視力老有14眼，而後者僅7眼。其視力也以眼球內注射攀爲佳。本報告所使用藥物為gentamycin等，劑量爲0.01~0.03mg in 0.1 c. c.，與一般文獻比較乃屬較低劑量。

並列摘要

Suppurative endophthalmitis is one of the disastrous diseases in the ophthalmological field. Since there is a blood-ocular barrier in the eye ball, drugs that are introduced conventionally either by oral administration or by intravenous, intramuscular and subconjunctival injections do not reach the effective level in the eye ball. That's why the prognosis for endophthalmitis is usually poor.
Most of the suppurative endophthalmitis is caused by penetrating injuries to the eye ball. Surgical infection eventually occurs and- intraocular infection rarely occurs through a filtering conjunctival bleb. In our series of 104 patients (106 eyes) that had penetrating injuries, 39 patients developed endophthalmitis. That is almost one third of the cases. Therefore it is imperative to prevent endophthalmitis after penetrating injuries. Since August 1975, we have tried the intra-ocular injection (IOI) of antibiotics for preventive and therapeutic treatment of endophthalmitis with rather encouraging results.
Of 75 patients (77 eyes) who came to the hospital within 24 hours after their injury, IOI of antibiotics was applied to 37 patients (39 eyes). Conventional administration of antibioicts was given to 38 patients (38 eyes). Of the IOI group, in which 22 patients (22 eyes) had corneal laceration, the antibiotics were injected into the anterior chamber after suturing of the wound. The other 15 patients (17 eyes) had combined corneal and scleral laceration, or intravitreal foreign body. So the antibiotics were injected through the scleral wound or pars plana into the vitreous body, or combined with the anterior chamber injection.
The drugs used were minocycline, sulbenicillin, and gentamycin which was more frequently used. The doses of above mentioned antibiotics were 0.01-0.03 mg in 0.1ml of Ringer's solution. Each case also received a combined subconjunctival injection of 12-20 mg gentamycin daily for 7-10 days.
Among 42 cases of endophthalmitis 39 developed after penetrating injuries. The rest of three endophthalmitis cases were one case following aspiration of the cataract, one infected scleral ulcer with inner segment involvement, and one case of late intraocular infection through a fistulizing bleb.
Among 42 patients (42 eyes) with endophthalmitis, 22 patients (22 eyes) received IOI and the other 20 patients (20 eyes) received conventional treatment. The injection site of IOI was either through the limbus into the anterior chamber or through the pars plana into the center of the vitreous body. The injection interval ranged 2 to 4 days depending on the rate of improvement of the, eyes.
Among 39 eyes that received preventive IOI antibiotic injection, only one case developed endophthalmitis as compared to the 7 eyes among those 38 eyes that received conventional antibiotic management.
Out of 22 patients (22 eyes) who received IOI. 14 patients (14 eyes) retained useful visions (better than 0.05, Landolt's test chart), 3 eyes were preserved without a useful vision, the other 5 patients lost their diseased eyes. Out of 20 patients who received conventional treatment only 7 patients retained useful vision, the other 13 patients lost their diseased eyes. The visual acuity was better in IOI group than the conventional treatment group.
The side effects of IOI encountered were:
1) corneal edema in 10 patients that recovered in 9. Irreversible bullous keratopathy was encountered in a case, our first case, who received rather a high dose of 0.2mg in 0.1ml gentamycin intracamerally. 2) Posterior capsular lens opacity in 6 patients out of which 1 patient developed nuclear opacity and further mature cataract 3(1/2) months later. 3) fibrin exudates increased in one case.
No significant ophthalmoscopic changes occurred due to IOI treatment. No vitreous hemorrhage or retinal detachment occurred during or after injection through the pars plana.
The dosages used in our cases were rather low as compared to the published cases. No side effects were encountered in cases in which intravitreal injections were repeated as frequent as up to 10 times.
It can be stated that the IOI of antibiotics is a safe and effective method both in the prevention and therapeutic treatment of endophthalmitis.

並列關鍵字

Penetrating eye injuries ； endophthalmitis ； intraocular injection of antibiotics