Chiquet Christophe, Aptel Florent, Combey-de Lambert Aurélie, Bron Alain M, Campolmi Nelly, Palombi Karine, Thuret Gilles, Rouberol Frédéric, Cornut Pierre-Loïc, Creuzot-Garcher Catherine
Grenoble Alpes University, Grenoble, France Department of Ophthalmology, University Hospital, Grenoble, France.
Department of Ophthalmology, University Hospital, Dijon, France.
Br J Ophthalmol. 2016 Oct;100(10):1388-92. doi: 10.1136/bjophthalmol-2015-307359. Epub 2016 Jan 22.
BACKGROUND/AIMS: To report the incidence, risk factors and prognosis of retinal detachment (RD) in patients who had vitrectomy for acute bacterial endophthalmitis after cataract surgery.
123 patients with acute postcataract endophthalmitis, consecutively treated with pars plana vitrectomy (PPV) were included by the French Institutional Endophthalmitis Study group, in a prospective multicentre cohort study. Risk factors of RD were analysed using logistic regression.
At the 6-month follow-up, the rate of post-PPV RD was 13% (n=16). The risk factors of post-PPV RD were diabetes (OR=4.7 (1.4-15.4), p=0.01) and visualisation of retinal vasculitis on the posterior pole (OR=3.8 (1.1-13.9), p=0.03) at the time of PPV. Postoperative RD occurred in 56% (n=9) of cases in the first month, in 31% (n=5) in the second month and in 6% (n=1) in the third month, with a mean delay of 47±71 days after PPV. The macula was detached in 12 cases (75%) and proliferative vitreoretinopathy grade C was present in seven cases. Final successful reattachment of the retina was obtained in 60% (n=9/15) of cases, with one (7/9) or two surgeries (2/9). Final visual acuity after surgical repair was ≥20/40 in 19% of cases, compared with 43% in patients without RD (p=0.05).
RD is a major and severe complication of PPV performed in patients with acute postcataract endophthalmitis. Retinal vasculitis is a major risk factor of RD after PPV. Anatomical and functional outcome remain poor.
背景/目的：报告白内障手术后因急性细菌性眼内炎接受玻璃体切割术的患者发生视网膜脱离（RD）的发生率、危险因素及预后情况。
法国机构性眼内炎研究组在一项前瞻性多中心队列研究中纳入了123例因急性白内障后眼内炎而连续接受玻璃体切割术（PPV）治疗的患者。采用逻辑回归分析RD的危险因素。
在6个月的随访中，PPV术后RD发生率为13%（n = 16）。PPV术后RD的危险因素为糖尿病（比值比[OR]=4.7[1.4 - 15.4]，p = 0.01）以及PPV时后极部视网膜血管炎的可见性（OR = 3.8[1.1 - 13.9]，p = 0.03）。术后RD在第一个月发生于56%（n = 9）的病例中，第二个月发生于31%（n = 5）的病例中，第三个月发生于6%（n = 1）的病例中，PPV后平均延迟时间为47±71天。12例（75%）黄斑脱离，7例存在增殖性玻璃体视网膜病变C级。60%（n = 9/15）的病例最终成功实现视网膜复位，其中1次手术（7/9）或2次手术（2/9）。手术修复后的最终视力≥20/40的病例占19%，而无RD患者中这一比例为43%（p = 0.05）。
RD是急性白内障后眼内炎患者接受PPV的一种主要且严重的并发症。视网膜血管炎是PPV术后RD的主要危险因素。解剖和功能结局仍然较差。
