角膜潰瘍併發眼內炎

Corneal Ulcer Complicated with Endophthalmitis

在眼內炎的病例中常有許多是因為角膜潰瘍所引起的，但是有關角膜潰瘍引起眼內炎的相關研究卻不多，尤其缺乏大規模的回溯性研究。本篇報告收進成大醫院十年來所有眼內炎的病例，整理其中和角膜潰瘍有關的病患，分析其臨床表現、致病菌種、治療及預後。我們發現：因角膜潰瘍引起的眼內炎共有18位，佔所有眼內炎的21%，若以引起眼內炎的原因來分類排名，則角膜潰瘍所引起的佔第二位，僅次於術後性眼內炎。引起的菌種，以綠膿桿菌最多，鏈球菌次之，黴菌佔第三位。病人的視力預後普遍不好，即使經過治療，大部分視力為無光覺。因此對於角膜潰瘍的病人若合併有長期使用類固醇、眼睛手術病史、原先視力為無光覺或角膜穿孔等相關因子，則要小心會有併發眼內炎的危險，最好能經常用超音波檢查。

corneal ulcer is one of the most important causes of endophthalmitis. There have been few large comtemporary studies of endophthlimitis in accociation with corneal ulcer,most reports have been of sporadic cases. In this report,we present the results of a 10-year retrospective review of cases of endophthalmitis associated with corneal ulcer at National Cheng Kung University Hospital. Our purpose was to characterize the predisposing factors, interval between the diagnosis of corneal ulcer and the onset of endophthalmitis, causative organisms, treatment, and visual outcome. During the study period, there were 86 cases of endophthalmitis, 18 (21%) of which were associated with corneal ulcer. Most of patients were infected by Pseudomonas aeruginosa. No light perception was the predominant post-treatment visual outcome. Patients with corneal ulcer associated with steroid use, ocular surgery, no light perception, and corneal perforation, may develop endophthalmitis. Serial ultrasound examinations are important for patients with these predisposing factors.