Waheed S, Ritterband D C, Greenfield D S, Liebmann J M, Seedor J A, Ritch R
Department of Ophthalmology, New York Eye and Ear Infirmary, NY, USA.
Eye (Lond). 1998;12 ( Pt 6):910-5. doi: 10.1038/eye.1998.237.
To report the risk factors, causative organisms and visual outcomes in patients with late-onset bleb-related endophthalmitis.
Medical records of all patients with the clinical diagnosis of late-onset bleb-related endophthalmitis undergoing vitreous aspirates for culture at our institution from January 1987 to July 1996 were reviewed. Late-onset bleb-related endophthalmitis was defined as conjunctival injection, bleb purulence and intraocular inflammation developing at least 1 month following filtering surgery.
Forty-nine cases of bleb-related endophthalmitis developed in 42 patients (23 men, 19 women). Mean patient age was 62.1 +/- 19.3 years (range 5-94 years). Thirty-nine patients underwent prior filtering surgery (superior trabeculectomy, 24 eyes; inferior trabeculectomy, 10 eyes; combined superior trabeculectomy/cataract extraction, 4 eyes; posterior lip sclerectomy, 1 eye) and 3 had inadvertent blebs following cataract extraction. Endophthalmitis developed an average of 25.4 +/- 23.5 months (range 1-96 months) post-operatively. Antifibrosis agents were used in 25 of 39 eyes undergoing filtering surgery (mitomycin C, 13 eyes; 5-fluorouracil, 12 eyes). Bleb leaks were documented in a total of 32 of 49 (65%) cases either before or at the time of endophthalmitis diagnosis. Vitreous cultures were positive in 42 of 49 (86%) cases. The most frequently cultured organisms were Staphylococcus aureus (13), Staphylococcus epidermidis (12), Streptococcus species (8) and Haemophilus influenzae (2). A final visual acuity of 20/400 or better was achieved in 32 of 49 (65%) cases.
Staphylococcal species were the most frequently cultured organisms in this series and may be associated with better visual outcomes. Although a causal relationship cannot be established, these results suggest a strong association between bleb leaks and endophthalmitis.
报告迟发性滤过泡相关眼内炎患者的危险因素、致病微生物及视力预后。
回顾1987年1月至1996年7月在我院因临床诊断为迟发性滤过泡相关眼内炎而接受玻璃体抽吸培养的所有患者的病历。迟发性滤过泡相关眼内炎定义为滤过手术后至少1个月出现结膜充血、滤过泡脓性渗出及眼内炎症。
42例患者（23例男性，19例女性）发生了49例滤过泡相关眼内炎。患者平均年龄为62.1±19.3岁（范围5 - 94岁）。39例患者曾接受过滤过手术（上方小梁切除术，24眼；下方小梁切除术，10眼；上方小梁切除术联合白内障摘除术，4眼；后唇巩膜切除术，1眼），3例在白内障摘除术后意外形成滤过泡。眼内炎平均在术后25.4±23.5个月（范围1 - 96个月）发生。在接受滤过手术的39眼中，25眼使用了抗纤维化药物（丝裂霉素C，13眼；5 - 氟尿嘧啶，12眼）。在49例（65%）病例中，共有32例在眼内炎诊断前或诊断时记录到滤过泡渗漏。49例中的42例（86%）玻璃体培养呈阳性。最常培养出的微生物为金黄色葡萄球菌（13例）、表皮葡萄球菌（12例）、链球菌属（8例）和流感嗜血杆菌（2例）。49例中的32例（65%）最终视力达到20/400或更好。
葡萄球菌属是本系列中最常培养出的微生物，可能与较好的视力预后相关。尽管无法确立因果关系，但这些结果提示滤过泡渗漏与眼内炎之间存在密切关联。
