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NR. 1/2006
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Wczesna witrektomia
złotym standardem w pourazowym zapaleniu wnętrza gałki ocznej
Immediate Vitrectomy as the Golden Standard in Posttraumatic
Endophthalmitis
Mariusz Kosatka
Klinika Okulistyczna Wojskowego Instytutu Medycznego Centralnego
Szpitala Klinicznego
Wojskowej Akademii Medycznej w Warszawie
Kierownik: prof. dr hab. n. med. Andrzej Stankiewicz |
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| Summary: |
Endophtalmitis is the most
severe consequences of penetrating ocular trauma.
Posttraumatic infectious endophthalmitis differs from
postoperative and endogenous endophthalmitis both in its
causative microorganisms and in its poorer visual
prognosis. The poor visual prognosis of posttraumatic
endophthalmitis (approximately 30% of patients achieve a
final visual acuity of 20/400 or better) is probably
concerned with the combination of ocular injury, the
different spectrum of infecting microbes and the greater
delay in treatment. The frequency of posttraumatic
endophthalmitis varies between 7% and even 30% in the
case of penetrating injures. The most common bacteria
which cause posttraumatic endophthalmitis are
Staphylococcus epidermidis and the most virulent
Bacillus cereus. Most Bacillus infections are associated
with intraocular foreign bodies. Lens capsule breach,
foreign body presence, contamined wound and primary
repair delay are the main factors of rising risk of
endophtalmitis. Immediate diagnosis and surgical
management allow retain useful outcome visual acuity.
The method of choice in the treatment of posttraumatic
endophthalmitis is in immediate pars plana vitrectomy (PPV)
the majority of patients. Vitrectomy has the potential
advantages of removing both the infecting organism and
assotiated toxins and vitreous membrane that could lead
to retinal detachment. It improves intraocular
distribution of antibiotics, too. |
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| Key words: |
endophthalmitis, trauma,
vitrectomy, antibiotics. |
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