目的：分析不同类型眼科术后感染性眼内炎的致病菌、耐药性、治疗方法及预后。

方法：回顾性分析。选取河北省人民医院眼科2009-01/2023-06收治的眼科术后感染性眼内炎患者37例37眼。分析不同类型眼科术后感染性眼内炎的致病菌、耐药性、早期玻璃体腔注射抗生素或玻璃体切除联合硅油填充术的治疗效果。

结果：纳入术后感染性眼内炎患者37眼中，白内障超声乳化摘除联合人工晶状体植入术后24眼，玻璃体切除术后4眼，青光眼白内障联合术后2眼，抗青光眼术后2眼，角膜移植术后2眼，前房穿刺术后2眼，玻璃体腔注药术后1眼。眼内液标本送检37例(玻璃体+房水14例，单纯玻璃体20例，单纯房水3例)，检出致病菌20株，其中革兰氏阳性菌17株(12例为表皮葡萄球菌)，革兰氏阴性菌2株，真菌1株(镰刀菌)。37眼中行单纯玻璃体腔注药 7眼、玻璃体腔注药联合玻璃体切除11眼、单纯玻璃体切除19眼。末次随访时，最佳矫正视力(BCVA)≤0.05者15眼，0.06-0.3者15眼，0.4-1.0者7眼，与治疗前(无光感-手动者31眼，数指-0.05者3眼，0.06-0.3者3眼)有差异(P<0.001)。

结论：对于眼内感染相对较轻、初诊视力相对较好的眼科术后感染性眼内炎患者，玻璃体腔注射抗生素仍然是一种经济有效的治疗手段。早期进行玻璃体切除术可以有效控制眼科术后感染性眼内炎的进展，减少手术次数，显著提高视力。

METHODS:A retrospective analysis was conducted on the clinical data of 37 patients(37 eyes)with infectious endophthalmitis secondary to different ophthalmic surgeries. All these patients were treated in the Ophthalmology Department of Hebei General Hospital between January 2009 and June 2023. The pathogenic bacteria, drug resistance and therapeutic effects of early intravitreal injection of antibiotics or vitrectomy combined with silicone oil filling were analyzed.

RESULTS:There were 24 eyes following cataract phacoemulsification combined with intraocular lens implantation, 4 eyes following vitrectomy, 2 eyes following combination surgery for glaucoma and cataract, 2 eyes following anti-glaucoma surgery, 2 eyes following corneal transplantation, 2 eyes following anterior chamber puncture, and 1 eye following intravitreal injection among the 37 eyes with infectious endophthalmitis. Totally 37 samples of intraocular fluid were submitted for bacterial and fungal culture, and 20 strains of pathogenic bacteria were identified, including 17 Gram-positive bacteria, 2 Gram-negative bacteria, 1 fusarium, and 12 cases were staphylococcus epidermidis. According to the final therapy, 7 eyes only treated by intravitreal injection, 11 eyes treated by intravitreal injection and vitrectomy, and 19 eyes only treated by vitrectomy. At the last follow-up, the best corrected visual acuity(BCVA)was ≤0.05 in 15 eyes, 0.06-0.3 in 15 eyes, and 0.4-1.0 in 7 eyes. Compared to before treatment(no light perception - hand movement in 31 eyes, counting fingers -0.05 in 3 eyes, 0.06-0.3 in 3 eyes), the difference was statistically significant(P<0.001).

CONCLUSION: For infectious endophthalmitis patients with relatively mild ocular manifestation and good initial visual acuity, intravitreal injection of antibiotics remains an economically viable and effective therapy option. Early vitrectomy may effectively prevent the progression of infectious endophthalmitis, reduce the number of surgeries, and significantly improve the vision outcomes.