摘要目的 总结儿童外伤性眼内炎临床特征和治疗转归,以指导临床治疗.方法 采用回顾性病例观察研究.纳入山东省眼科医院2014年4月至2017年4月收治的26例26眼诊断为儿童外伤性眼内炎1～13岁患儿的病历资料,总结分析年龄、致伤物、接受治疗时间、治疗方式、并发症和患眼视力等;根据预后状态对患儿进行预后分级,并比较不同就诊时间、玻璃体切割手术时间、手术次数、抗生素应用情况下患儿预后情况. 结果 26例患儿中男20例,女6例,年龄1 ～13岁,平均年龄(6.56±3.25)岁.根据年龄将患者分为婴幼儿组(0～2岁)2例,占7.69％,学龄前组(3～5岁)10例,占38.46％,学龄组(6～14岁)14例,占53.85％.主要致伤物为铁丝电线,占34.62％ (9/26);其次为注射器针头,占15.38％ (4/26);烟花爆竹占11.54％(3/26).26例患儿入院后均行玻璃体切割术,其中联合晶状体摘出术者24例,占92.31％.26例患儿中8例无初视力记录,其余18眼末次随访患儿视力较术前初视力明显提高,差异有统计学意义(x2=7.385,P=0.033).房水和玻璃体液病原微生物培养阳性率为23.08％ (6/26),菌种以革兰阳性球菌为主,占83.3％ (5/6).预后分级1级15例,占57.7％,2级7例,占26.9％;3级4例,占15.4％.不同就诊时间、接受玻璃体切割手术时间患儿预后分级例数比较,差异均有统计学意义(均P＜0.05).不同就诊时间组、接受玻璃体切割手术时间组、手术次数组以及是否全身应用抗生素组与预后分级明显相关(rs=0.580、0.414、0.428、0.535,均P＜0.05).结论 儿童外伤性眼内炎危害严重,尽早就诊并接受玻璃体切割术可改善患儿预后.

abstractsObjective To investigate the clinical feature and treatment outcome of paediatric posttraumatic endophthalmitis.Methods A retrospective case study was performed.Twenty-six paediatric posttraumatic endophthalmitis children with 26 eyes were enrolled in Shandong Eye Hospital from April 2014 to April 2017.The clinical features,causes of trauma,time and mode of treatment,complications and visual acuity were analyzed.The subjects were graded according to the prognostic status,and the prognosis of the children was compared among different treatment time,vitrectomy time,operation frequency and antibiotic application.Results Of 26 cases,including 20 males and 6 females,aged from 1 year to 13 years,the average age was (6.56±3.25) years.The subjects were divided into infant group (2 cases,7.69％),preschool group (10 cases,38.46％) and school age group (14 cases,53.85％).The main cause of injury was wire,accounting for 34.62％ (9/26).Syringe needles accounted for 15.38％ (4/26).Fireworks accounted for 11.54％ (3/26).All of the 26 cases received vitrectomy,24 cases combined with lens extraction (92.31％).Among the 26 cases,8 cases had no primary visual acuity record;in the remaining 18 cases,the visual acuity at last follow-up was significantly improved when compared with the preoperative primary visual acuity (x2 =7.385,P =0.033).The positive rate of pathogenic bacteria culture in aqueous humor and vitreous humor was 23.08％ (6/26),gram-positive cocci was the main pathogenic bacteria of posttraumatic endophthalmitis,which account for 83.3％ (5/6).The prognostic grade was grade 1 in 15 cases (57.7％),grade 2 in 7 cases (26.9％) and grade 3 in 4 cases (15.4％).There were significant differences in the number of prognostic grading cases among children with different hospitalizing time or vitrectomy time (all at P＜0.05).The hospitalizing time,time of vitrectomy,number of operations and systemic application of antibiotics were positively correlated with the prognosis grade (rs =0.580,0.414,0.428,0.535;all at P ＜ 0.05).Conclusions Children with posttraumatic endophthalmitis should undergo vitrectomy as early as possible,which can receive better prognosis.