Gupta Arvind, Srinivasan Renuka, Kaliaperumal Subashini, Setia Sajita
Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Clin Exp Ophthalmol. 2007 Jul;35(5):432-8. doi: 10.1111/j.1442-9071.2007.01509.x.
To determine the risk factors leading to positive intraocular culture in patients with open globe injury.
A prospective interventional study involving 110 eyes of 110 patients of more than 15 years of age, presenting with open globe injury, was undertaken. Emergency repair of the injured globe was done. Prolapsed intraocular tissue or aqueous humour was sent for microbial work up before repair. In endophthalmitis cases intravitreal antibiotics were given according to the antimicrobial sensitivity. Chi-square and logistic regression analysis were used to determine the risk factors.
Fifty-six patients showed microbial contamination. Bacteria were cultured in 42 patients and fungi in 14 patients. Nineteen patients developed endophthalmitis, of which 18 patients showed microbial growth initially. In univariate analysis, initial visual acuity (<6/360, P = 0.002), presence of uveal tissue prolapse (P < 0.001), vitreous prolapse (P < 0.001) and length of laceration (>8 mm, P < 0.001) were significantly associated with positive microbial culture, however, in the multivariate stepwise logistic regression delay in surgical intervention (>72 h, P < 0.001), uveal tissue prolapse (P = 0.004) and corneosclearal laceration (>8 mm, P = 0.013) were associated with increased risk of positive microbial culture. Six patients had intraocular foreign body but were culture negative. Age, gender, site of injury and presence of cataract did not significantly affect the culture positivity.
Microbial contamination is a risk factor for the development for endophthalmitis. Despite the high frequency of microbial contamination, it develops only in few cases. Systemic antibiotics, virulence of the organism and host factors play a role in the manifestation of endophthalmitis. Prophylaxis with intraocular antibiotics should be strongly considered in cases with poor vision at presentation, larger corneoscleral laceration, delayed surgical intervention and uveal tissue or vitreous prolapse.
确定开放性眼球损伤患者眼内培养阳性的危险因素。
对110例15岁以上开放性眼球损伤患者的110只眼进行前瞻性干预研究。对受伤眼球进行急诊修复。修复前将脱出的眼内组织或房水送去做微生物检查。对于眼内炎病例，根据抗菌药敏结果给予玻璃体内注射抗生素。采用卡方检验和逻辑回归分析来确定危险因素。
56例患者显示有微生物污染。42例培养出细菌，14例培养出真菌。19例发生眼内炎，其中18例最初显示有微生物生长。单因素分析中，初始视力（<6/360，P = 0.002）、葡萄膜组织脱出（P < 0.001）、玻璃体脱出（P < 0.001）和伤口长度（>8 mm，P < 0.001）与微生物培养阳性显著相关，然而，在多因素逐步逻辑回归分析中，手术干预延迟（>72小时，P < 0.001）、葡萄膜组织脱出（P = 0.004）和角巩膜伤口（>8 mm，P = 0.013）与微生物培养阳性风险增加相关。6例有眼内异物但培养阴性。年龄、性别、损伤部位和白内障的存在对培养阳性率无显著影响。
微生物污染是发生眼内炎的一个危险因素。尽管微生物污染频率高，但仅在少数病例中发生眼内炎。全身使用抗生素、病原体毒力和宿主因素在眼内炎的表现中起作用。对于就诊时视力差、角巩膜伤口大、手术干预延迟以及葡萄膜组织或玻璃体脱出的病例，应强烈考虑眼内抗生素预防。
