Injury Prevention Research Center, Medical College of Shantou University Shantou, Guangdong Province, People's Republic of China ; Department of Ophthalmology, C-MER(Shenzhen)Dennis Lam Eye Hospital, Shenzhen, Guangdong Province, People's Republic of China.
PLoS One. 2013 Aug 26;8(8):e71731. doi: 10.1371/journal.pone.0071731. eCollection 2013.
Acute endophthalmitis is one of the most serious complications of cataract surgery and often results in severe visual impairment. Several risk factors for acute postoperative endophthalmitis (POE) following cataract surgery have been reported but the level of evidence and strength of association is varied. The purpose of this study was to critically appraise published reports on and to summarize clinical risk factors associated with acute POE which could be easily assessed by ophthalmologists for the introduction and implementation of preventive measure.
A systematic review and meta-analysis of observational studies was performed. Six databases were searched with no limits on the year or language of publication. Study-specific odds ratios (Ors) or relative risk (RR) of each risk factor were pooled using a random effect model.
A total of 6 686 169 participants with 8 963 endophthalmitis in 42 studies were analyzed. Of the nine risk factors identified in our systematic review and meta-analysis, extra- or intracapsular cataract extraction, a clear corneal incision, without intracameral cefazolin (1 mg in 0.1 ml solution), without intracameral cefuroxime (1 mg in 0.1 ml solution), post capsular rupture, silicone intraocular lenses and intraoperative complications were found strongly associated with acute endophthalmitis. Other significant factors with a lower strength of association (risk estimates generally 1.5 or less) were male gender and old age (85 years and older).
Our study provides summary data on the risk factors for acute POE. Identifying patients at high risk of this sight-threatening eye disease is important from both the public health and clinical perspectives as this would facilitate detection of disease before the onset of irreversible visual loss enabling earlier intervention.
急性眼内炎是白内障手术后最严重的并发症之一，常导致严重视力损害。已经报道了几种白内障手术后急性术后眼内炎（POE）的危险因素，但证据水平和关联强度各不相同。本研究的目的是批判性地评价已发表的关于白内障手术后急性 POE 相关临床危险因素的报告，并对其进行总结，这些危险因素可通过眼科医生进行评估，以便引入和实施预防措施。
对观察性研究进行系统评价和荟萃分析。无发表年份和语言限制，对 6 个数据库进行了检索。使用随机效应模型汇总每个危险因素的研究特异性比值比（Ors）或相对风险（RR）。
共分析了 42 项研究中的 6686169 名参与者和 8963 例眼内炎。在我们的系统评价和荟萃分析中确定的 9 个危险因素中，囊外或囊内白内障摘除术、透明角膜切口、未行前房内头孢唑林（0.1ml 溶液中 1mg）、未行前房内头孢呋辛（0.1ml 溶液中 1mg）、后囊破裂、硅油眼内晶状体和术中并发症与急性眼内炎强烈相关。其他具有较低关联强度（风险估计值一般为 1.5 或更低）的显著因素包括男性和高龄（85 岁及以上）。
我们的研究提供了关于急性 POE 危险因素的汇总数据。从公共卫生和临床角度来看，识别患有这种威胁视力的眼部疾病的高危患者很重要，因为这有助于在不可逆转的视力丧失发生之前发现疾病，从而能够更早地进行干预。
