Nentwich Martin M, Ta Christopher N, Kreutzer Thomas C, Li Bing, Schwarzbach Fabian, Yactayo-Miranda Yazmin M, Kampik Anselm, Miño de Kaspar Herminia
From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
From the Department of Ophthalmology (Nentwich, Kreutzer, Li, Schwarzbach, Yactayo-Miranda, Kampik, Miño de Kaspar), Ludwig-Maximilians-University, Munich, Germany; the Department of Ophthalmology (Ta), School of Medicine, Stanford University, Stanford, California, USA.
J Cataract Refract Surg. 2015 Jan;41(1):58-66. doi: 10.1016/j.jcrs.2014.04.040.
To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period.
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Retrospective chart review.
Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone-iodine 10.0% periorbitally, and 1 drop of povidone-iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%.
The overall rate of postoperative endophthalmitis was 0.113% (77/68,323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19,413) in period 2 to 0.065% (28/43,405) in period 3 (P < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24,034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14,676) in period 3 (P < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%).
The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone-iodine might have been the most important contributor.
No author has a financial or proprietary interest in any material or method mentioned.
探讨20年间术后眼内炎的发生率与术前预防措施变化之间的相关性。
德国慕尼黑路德维希-马克西米利安大学眼科。
回顾性病历审查。
纳入1990年至2009年在同一机构接受眼内手术后被诊断为术后眼内炎的患者。由于研究期间术前预防措施的变化，将患者分为3组进行数据分析：第1阶段（1990年至1992年），无标准化预防方案；第2阶段（1993年至1998年），术前局部用药，10.0%聚维酮碘眶周用药，结膜囊内滴入1滴1.0%聚维酮碘；第3阶段（1999年至2009年），与第2阶段相似，但结膜囊用10 mL 1.0%聚维酮碘冲洗。
所有眼内手术的术后眼内炎总发生率为0.113%（77/68,323）。从第1阶段的0.291%（16/5505）显著降至第2阶段的0.170%（33/19,413），再降至第3阶段的0.065%（28/43,405）（P <.001）。在白内障手术中，术后眼内炎总发生率为0.125%（30/24,034）。在随后的每个阶段均下降，从第1阶段的0.338%（9/2662）降至第2阶段的0.224%（15/6696），再降至第3阶段的0.041%（6/14,676）（P <.001）。凝固酶阴性葡萄球菌是最常分离出的病原体（47.4%）。
在一所学术机构中，术后眼内炎的发生率在20年间有所下降。尽管多种因素可能导致了这种下降，但采用大量聚维酮碘的术前预防方案的实施可能是最重要的因素。
无作者对文中提及的任何材料或方法有财务或专利权益。
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