Rahimi Mansour, Ghassemifar Vahid, Nowroozzadeh Mohammad Hosein
Poostchi Ophthalmology Research Center, Shiraz School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Middle East Afr J Ophthalmol. 2012 Jan;19(1):107-14. doi: 10.4103/0974-9233.92125.
The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery.
In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance
During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration.
The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ≥20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment.
本研究旨在调查白内障手术后急性眼内炎的致病微生物、临床特征、视力预后及发病率。
在这项回顾性研究中，对2005年1月至2009年12月在一家三级转诊中心接受白内障手术后急性眼内炎治疗的患者进行了病历审查。在研究期间，另有62例急性术后眼内炎患者被转诊至该中心并接受治疗。因此，该队列包括70例患者（其中8例在我们中心接受白内障手术，62例为转诊患者）。对人口统计学、临床和实验室数据进行了分析。主要结局指标为最终视力。P<0.05表示具有统计学意义。
在研究期间，该中心共进行了7737例白内障手术。7737只眼中有8只（0.10%）发生了急性术后眼内炎。亚组分析表明，与超声乳化白内障吸除术相比，囊外白内障摘除术发生眼内炎的风险高四倍。我们发现，较好的初始视力（VA）（≥手动）（P<0.001）和阴性培养结果（P=0.021）与更有利的视力预后独立相关。伴有相对性传入性瞳孔障碍（RAPD）的患者初始视力较低（P<0.001），视力预后较差（P=0.001）。33例（42.9%）病例微生物培养结果为阳性。金黄色葡萄球菌是最常见的分离出的微生物。RAPD患者培养结果阳性更为常见。“革兰氏阳性凝固酶阴性”组和“无生长”组视力预后最佳。伴有角膜炎和避免使用眼内类固醇与眼球摘除风险相关。
眼内炎后的视力预后通常较差，只有八分之一的患眼最终矫正视力达到≥20/200。因此，需要更好的治疗策略。立即治疗至关重要，一期玻璃体切除术的作用需要进一步研究。此外，RAPD作为一种客观检查，可补充视力用于预测预后和规划治疗方案。
