Wallin Örjan, Al-ahramy Abdullah M, Lundström Mats, Montan Per
Department of Anterior Segment, St Erik Eye Hospital, Stockholm, Sweden.
Acta Ophthalmol. 2014 Aug;92(5):426-31. doi: 10.1111/aos.12257. Epub 2013 Sep 11.
To study the epidemiology and risk factors of early- and late-onset postoperative endophthalmitis (PE) and severe blebitis following trabeculectomy.
Retrospective, single-centre, observational study with a case-control design in part. Patients sustaining PE and severe blebitis following trabeculectomy or a combined trabeculectomy with a cataract extraction procedure performed from 1990 through 2008 and diagnosed from 1990 through 2012 were recorded at St Erik Eye Hospital. Incidence data were calculated with help from the hospital records. Notes data of cases and of six randomly selected but procedure matched control patients for each case were compared.
The joint rate of infection was 0.46% or 34 incidents in 7402 procedures. The frequency of early (occurring <6 weeks after surgery) onset PE was 0.19%, late PE was 0.19% and severe blebitis was 0.08%. Dominating aetiologies were staphylococci and streptococci. Overall, the infection severely impaired the visual function. Combined cataract and fistulating operations were less prone to develop late infections, p = 0.04, but no other decisive factors were identified in the case-control study. Data collection for all trabeculectomy surgeries from 1998 and onward identified an increased rate for late infection with the use of mitomycin C (MMC), 8 in 1171 surgeries or 0.7%, versus no such use, 0 case of late PE in 2136 surgeries, p < 0.001.
Postoperative endophthalmitis is a devastating complication after trabeculectomy. The use of MMC increases the risk for delayed infection. Early PE after trabeculectomy is clearly more common than PE after cataract surgery. Developing efficacious prophylactic antibiotic regimens to reduce early PE after penetrating filtering procedures should be a major priority in ophthalmic surgery.
研究小梁切除术后早发性和迟发性术后眼内炎（PE）及严重睑缘炎的流行病学和危险因素。
部分采用病例对照设计的回顾性单中心观察性研究。记录1990年至2008年期间在圣埃里克眼科医院接受小梁切除术或小梁切除术联合白内障摘除术且于1990年至2012年确诊的发生PE和严重睑缘炎的患者。借助医院记录计算发病率数据。比较病例及为每个病例随机选取的6例手术匹配对照患者的病历数据。
7402例手术中感染的联合发生率为0.46%，即34例感染事件。早发性（术后<6周发生）PE的发生率为0.19%，迟发性PE为0.19%，严重睑缘炎为0.08%。主要病因是葡萄球菌和链球菌。总体而言，感染严重损害视功能。白内障联合造瘘手术发生迟发性感染的可能性较小，p = 0.04，但病例对照研究未发现其他决定性因素。对1998年及以后所有小梁切除术的数据收集发现，使用丝裂霉素C（MMC）后迟发性感染率增加，1171例手术中有8例，即0.7%，而未使用MMC的2136例手术中迟发性PE为0例，p < 0.001。
术后眼内炎是小梁切除术后一种极具破坏性的并发症。使用MMC会增加延迟感染的风险。小梁切除术后早发性PE明显比白内障手术后的PE更常见。制定有效的预防性抗生素方案以降低穿透性滤过手术后的早发性PE应是眼科手术的主要优先事项。
