【摘要】 目的 探讨儿童眼内炎的临床特点，研究玻璃体手术的治疗效果。方法 总结分析2001年1月～2002年12月我院住院患者中儿童眼内炎病例。结果 儿童眼内炎共62例62眼，平均年龄7.61岁(1～14岁)，男女比例约为6∶1(男53例，女9例)。62眼中，外伤性眼内炎55眼(88.71%)，其中，一次性注射器23眼(41.82%)。涂片或培养阳性22眼(44.00%)，真菌9眼(18.00%)，细菌13眼(26.00%)，其中杆菌7眼(53.85%)。46眼行玻璃体手术，联合晶状体切除39眼(84.78%)，巩膜环扎31眼(67.39%)，气体填充24眼(52.17%)，硅油填充5眼(10.87%)；术中医源性裂孔21眼(45.65%)，锯齿缘截离11眼(23.91%)；术后高眼压5眼(10.87%)，低眼压3眼(6.52%)，角膜带状变性3眼(6.52%)，白内障3眼(6.52%)，复发性视网膜脱离3眼(6.52%)。随访3～18个月，除眼球或眶内容剜除4眼，放弃治疗4眼，视力检查不合作8眼，其余46眼治疗后视力改善28眼，稳定17眼，减退1眼； 其中，Ⅰ组(玻璃体腔注药+玻璃体手术25眼)视力改善15眼，稳定7眼，减退1眼；Ⅱ组(单纯玻璃体手术12眼)视力改善9眼，稳定3眼；Ⅲ组(单纯玻璃体腔注药9眼)视力改善2眼，稳定7眼。经Mann-Whitney t检验，Ⅰ组与Ⅲ组，Ⅱ组与Ⅲ组手术后视力差异有显著性意义(P<0.05)，Ⅰ组与Ⅱ组手术后视力差异无显著性意义(P>0.05)。结论 儿童眼内炎由于眼球结构、组织发育、生理、心理及社会特点有别于成人，玻璃体腔注药效果欠佳，是致盲的主要原因。绝大多数儿童眼内炎，一经诊断明确，应立即行玻璃体手术，多数患儿的炎症得到控制，视力得到改善。

    【关键词】 儿童眼内炎;玻璃体切割术

    Analysis of outcomes of vitrectomy for endophthalmitis in children

    LUO Xiao-gang, YAO Jing, XU Ge-zhi.

    The Affiliated Eye Ear Nose Throat Hospital of Fudan University, Shanghai 200031, China

    【Abstract】 Objective To study the clinical features and management of endophthalmitis in children.Methods 62 children (62 eyes) with a clinical diagnosis of endophthalmitis from Jan, 2001 to Dec, 2002 were retrospectively studied.Results The median age of 62 children was 7.61 years (range, 1～14 years). Most of those were male (male∶female = 6∶1). For the causes, 23 eyes (37.10%) were injured by disposable syringe, 12 eyes (19.35%) by metallic foreign body, 12 eyes (19.35%) by vegetant foreign body, 3 eyes (4.84%) by firecracker, 5 eyes (8.06%) by other causes and 7 eyes (11.29%) undetermined. 21 cases (33.87%) were positive in smear or culture, 10 cases (16.13%) for fungus, 11 cases (17.74%) for bacterium, furthermore, 7 cases (63.64%) for bacillus. After treatment, all cases were controlled. Visual acuity was improved in 23 eyes and stable in 12 eyes. For those with vitrectomy, visual acuity was improved in 22 eyes (47.83%) and stable in 8 eyes (17.39%). For those without operation, visual acuity was improved in 1 eye (8.33%) and stable in 4 eyes (33.33%). The difference was statistically significant (P<0.05). 30 eyes (61.22%) underwent intravitreal injection. Visual acuity was independent of intravitreal injection.Conclusion Disposable syringe was the main cause for endophthalmitis in children and should be warned. The rate of fungal endophthalmitis was rising and bacillus was still the main pathogen for bacterial endophthalmis in children. As for the clinical features of endophthalmitis in children, vitrectomy with lensectomy and buckling was recommended. Endophthalmitis in children should be diagnosed and managed as soon as possible. Most cases were controlled and visual acuity was improved with vitrectomy. ......