Endophthalmitis–眼內炎

* endogenous endophthalmitis – 最常來自endocarditis, 及GI tract
* endogenous fungal endophthalmitis以candida最常見
* chronic postoperative endophthalmitis：最常見P. Acnes

---

* endogenous Yeast (Candida) endophthalmitis：常見於indwelling cathetics, chronic antibiotic users, abdomen surgery (IV營養)
 multiple subretinal infiltration => mushroom shaped
 IV amphotericin B穿透力不好，但fluconazole則很好，但systemic SE少

---


* 在liver transplant後最常見的endogenous endophthalmitis→Endogenous Mold (Aspergillus) endophthalmitis（重要！）
=> lesion比candida大且進展快
=> 用amphotericin B，持別有vitritis時

---

* post. traumatic endophthalmitis發生率為2-7%
=> Bacillus cerus佔25%致病菌（考！）
=> 其與soil-contaminated injury有關，對vancomycin及clidamycin會sensitive
=> risk可用primary wound closure及早期FB removal來降低

---

postoperative endophthalmitis可分為

* Acute onset: 在intraocular surgery 6周內
 致病菌
 coagulative negative staphylococcus
 S. aureus
 Staphylococcus
 G(-) organism
 Chronic onset：

* 距intraocular surgery >6周
 致病菌
 propionibacterion
 coagulase negative staphylococcus
 fungi
 Bleb-associated endophthalmitis

* Months or years after surgery
 致病菌
 Streptococcus
 hemophilus
 G(+) organism

---

Endophthalmitis associated with conjunctival filtering bleb

一旦blebitis → endothphalmitis，則用IVI做treatment
* 常見菌：streptococcus, hemophilus, 其毒性強，即使立即治療，prognosis也比acute endophthalmitis還要差！

---

IV及oral antibiotics對cataract術後發生的endophthlmitis無效。
但是IV antibiotics對bleb-related endophthalmitis有效！

---

intraocular surgery如何prevent endophthalmitis？

 術前用antibiotic drop及術中用infusion antibiotics
 尚未證明可prevent endophthalmitis
 β-iodine則證明可減少culture-proven endophthalmitis

---

術式的影響

* 開phaco時，clear cornea incision比limbal/scleral approach之endophthalmitis機會較大
* ECCE比於ICCE較少發生endophthalmitis
* 開刀拚時間快也不會降低endophthalmitis的發生機率（一切都是天命…）

---

若是P. acne所引起的endophthalmitis，最重要的是要把PCO membrane用YAG打掉！（AAO習題）

---

Endophthalmitis Vitrectomy Study (EVS)

IVI : （急性期幾乎都要來一針的啦）

 0.4mg/0.1ml Amikin
 1mg/0.1ml vancomycin
 conjunctival injection:
 25mg vancomycin
 100mg ceftazine
 6mg dexamesasone
 14mg/ml Amikin

視力LP以上，打IVI和做vitrectomy的visual prognosis沒有差別。
但視力在LP以下，則做過VT的病患visual prognosis會比單純IVI來得好。

culture結果：約7% culture positive
其中70%是coagulase(-) staphylococcus

最終視力:
 50% > 20/40 (0.5)
 74% > 20/100 (0.2)