Hanscom Thomas A
Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, and Saint John's Hospital, Santa Monica, California, USA.
Clin Infect Dis. 2004 Feb 15;38(4):542-6. doi: 10.1086/381262. Epub 2004 Jan 26.
Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.
术后眼内炎仍是眼科领域一个严重的临床问题，发病率约为0.5%。预后很大程度上取决于致病微生物的毒力。眼内炎玻璃体切割术研究（EVS）是一项前瞻性随机试验，比较了白内障手术后发生眼内炎时的各种诊断和治疗方式。EVS发现，玻璃体切割术仅对视力极差的患者有益，并且与单纯玻璃体内抗生素治疗相比，静脉注射抗生素并无额外益处。然而，EVS存在的不足使得这些结论未来可能会有所修正。术前将聚维酮碘制剂应用于皮肤和结膜是唯一经证实有效的眼内炎预防措施。眼内炎可能是慢性的，可继发于青光眼手术以及玻璃体内注射气体和药物后。尽管这些情况具有可能需要改变患者管理方式的特定特征，但EVS并未对这些问题进行研究。
