感染性眼内炎の臨床的検討

Clinical features of endophthalmitis

　1991年8月〜1993年9月の2年2か月間に横浜市大眼科を受診した感染性眼内炎10症例について，年齢，性差，背景因子，発症動機，症状，起炎菌，治療，視力予後を検討した。症例の内訳は真菌性眼内炎が6例8眼，細菌性眼内炎が4例4眼であった。真菌性眼内炎では6例全例にintravenoushyperalimentation （IVH）の既往が認められた。細菌性眼内炎は外傷性1例，術後1例，内因性2例であった。真菌性眼内炎は全例フルコナゾール投与による治療を行ったが，視力予後は比較的良好であった。細菌性眼内炎は全例に抗生物質投与と硝子体切除術を行ったが，視力予後は症例によって分かれた。細菌性眼内炎は視力予後が悪く，速やかな診断と治療が重要であると考えられた。

We reviewed ten cases of infectious endophthalmitis during the foregoing 26 months. The endophthalmitis was due to fungal organisms in 6 and bacterial in 4. All the cases of fungal endophthalmitis had the history of intravenous hyperalimentation. The bacterial endophthalmitis was due to penetrating ocular trauma 1 eye, cataract surgery 1 and endogenous infection 2. In 3 of 6 cases of fungal endophthalmitis, Candida albicans was isolated from the blood or the wound. Two of 4 cases of bacterial endophthalmitis were microbiologically diagnosed through aqueous or vitreous tap. One was caused by Enterobacter cloacae and another by Klebsiella pneumoniae. All cases of fungal endophthalmitis were treated with systemic fluconazol and resulted in good visual acuity. All the cases of bacterial endophthalmitis were treated by systemic antibiotics and vitrectomy, resulting in good visual acuity in 1 and in poor visual outcome in 3. Early diagnosis was crucial for better visual outcome, particularly in cases of bacterial endophthalmitis.