最新ENDOPHTHALMITIS：眼内炎教学讲义PPT.ppt

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1、ENDOPHTHALMITIS：眼内炎EndophthalmitisThetermreferstointraocularinflammationpredominantlyinvolvingthevitreouscavityandA/C,asaresultofintraocularcolonizationbymicrorganisms.PathophysiologyIn29–43%ofcataractsurgery,intraocularcontaminationoccurswithfacultativebacteriafromocularsurfacewithou

2、tdevelopmentofendophthalmitis.Immuneprivilegemechanismsareparticularlyeffectiveintheanteriorpartoftheeye.Signsandsymptoms*DecreaseVA.*pain.*A/Creaction+/-hypopyon.*Vitritis.*others:lidswelling,discharge,C.edema,chemosis.D.Dx*TASS.*Complicated,prolongsurgery.*Preexistinguveitis.*Retain

3、edlensmaterial.*Associatedocularinjury.NB:presenceofsignificantvitritis=infectiousEndoph.Tillprovenotherwise.MicrobialspectrumPostcataract:CNS33-77%Staph.Aurus10-21%Streptococci9-19%G–ve,fungi6-22%Delayedonset(chronic)postcataract:Prop.Acne,corynebacteria,fungi.PostglaucomaSx:CNS67%ea

4、rlyStrept,Hinflu.Cont.Posttraumatic:CNS16–44%Bacillus17–32%G-ve10-18%Strept.8–21%Fungi4–14%Sourceofinfection*Mainlyeyelidsandconjunctiva.*Othersources:e.g.-lacrimaldrainagesyst.Infections.-Blephritis.-infectedsocketincontralateralprostheticeye.RiskfactorsforEndoph.Postcataractsurgery*

5、DisruptionoftheintegrityofthebarrierbetweenA/SandP/S(post.Caps.tear,zonulardialysis,vitreousloss).*clearcornealincision>scleraltunnel.*woundleakageinthefirstdaypostop.*SiliconIOL>PMMA.*nodifferenceofincidencebetweensuturelessandsuturetechniqueifnoleak.*Nodiff.betweeninpatientsandoutpa

6、tients.*Nodiff.betweenDMandnonDM.*Nodiff.betweendisposableandreusableinstruments.Prophylaxis*Antiseptics:5%povidone–iodineforatleast3minutesisthemostimportantprophylaxisinmanystudies;decreasingconj+periorbit.skinflora.*Singleuseinstrumentsisalwayspreferableesp.tubes.*therehasbeennoran

7、domisedcontrolledstudiesofpreoperativecuttingofeyelashes,availabledataintheliteratureshowednoassociationwiththereductionoftheriskofEndoph.*Buttapingbackofthelasheswithadhesivetapeisrecommended.*Treatanyunderlyingpredisposingcausee.g.blephritis.AntibioticsTopicalantibioticsesp.4thgener

8、ation