Nouri M, Terada H, Alfonso E C, Foster C S, Durand M L, Dohlman C H
Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
Arch Ophthalmol. 2001 Apr;119(4):484-9. doi: 10.1001/archopht.119.4.484.
To determine the rate of endophthalmitis in a group of patients with keratoprostheses and to analyze possible risk factors.
A total of 108 patient eyes, operated on between 1990 and 2000 with double-plated keratoprostheses, were analyzed with regard to the surface flora, the incidence and cause of bacterial endophthalmitis or sterile vitreitis, the keratoprosthesis design, prophylactic antibiotics, concomitant immunosuppression, and preoperative diagnosis.
Surveillance cultures were obtained from 30 uninfected eyes. The flora was similar to that reported in the normal population and did not vary significantly with time. Thirteen cases of bacterial endophthalmitis occurred 2 to 46 months postoperatively in the patient population that had been followed up for 2 months to 17 years (average, 3 years 4 months). The incidence was 39% in 13 patients with Stevens-Johnson syndrome, 19% in 27 patients with ocular cicatricial pemphigoid, and 7% in 28 patients with ocular burns. Only 1 of the other 40 cases (consisting mostly of repeated graft failures in noncicatrizing conditions) developed endophthalmitis; this patient had a filtering bleb. All endophthalmitis pathogens were gram positive: Streptococcus pneumoniae, 23%; other streptococci, 39%; Staphylococcus aureus, 23%; and Staphylococcus epidermidis, 15%.
The most important risk factor for endophthalmitis after these keratoprostheses was found to be preoperative diagnosis. The rate of infection was very high in Stevens-Johnson syndrome and ocular cicatricial pemphigoid, moderate in chemical burns, and low in noncicatrizing corneal disease.
确定一组角膜移植患者的眼内炎发生率，并分析可能的危险因素。
对1990年至2000年间接受双板角膜移植手术的108只患眼进行分析，内容包括表面菌群、细菌性眼内炎或无菌性玻璃体炎的发生率及病因、角膜移植设计、预防性抗生素使用、伴随的免疫抑制情况以及术前诊断。
从30只未感染的眼中获取了监测培养物。菌群与正常人群报告的相似，且随时间无显著变化。在随访2个月至17年（平均3年4个月）的患者群体中，术后2至46个月发生了13例细菌性眼内炎。13例史蒂文斯 - 约翰逊综合征患者中的发生率为39%，27例瘢痕性类天疱疮性角结膜炎患者中的发生率为19%，28例眼部烧伤患者中的发生率为7%。其他40例（主要为非瘢痕形成性疾病中的反复移植失败）中只有1例发生眼内炎；该患者有一个滤过泡。所有眼内炎病原体均为革兰氏阳性菌：肺炎链球菌，23%；其他链球菌，39%；金黄色葡萄球菌，23%；表皮葡萄球菌，15%。
发现这些角膜移植术后眼内炎的最重要危险因素是术前诊断。史蒂文斯 - 约翰逊综合征和瘢痕性类天疱疮性角结膜炎的感染率非常高，化学烧伤中感染率中等，非瘢痕形成性角膜疾病中感染率低。
