Wczesna witrektomia złotym standardem w pourazowym zapaleniu wnętrza gałki ocznej
Immediate Vitrectomy as the Golden Standard in Posttraumatic Endophthalmitis
Klinika Okulistyczna Wojskowego Instytutu Medycznego Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej w Warszawie Kierownik: prof. dr hab. n. med. Andrzej Stankiewicz
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.
Keywords: endophthalmitis, trauma, vitrectomy, antibiotics.