Sridhar Jayanth, Yonekawa Yoshihiro, Kuriyan Ajay E, Joseph Anthony, Thomas Benjamin J, Liang Michelle C, Rayess Nadim, Relhan Nidhi, Wolfe Jeremy D, Shah Chirag P, Witkin Andre J, Flynn Harry W, Garg Sunir J
*Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; †Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida; ‡Associated Retinal Consultants, William Beaumont Hospital, Oakland University School of Medicine, Royal Oak, Michigan; §Ophthalmic Consultants of Boston, Boston, Massachusetts; and ¶New England Eye Center, Tufts University School of Medicine, Boston, Massachusetts.
Retina. 2017 Jul;37(7):1246-1251. doi: 10.1097/IAE.0000000000001358.
To report the clinical presentation, microbiologic spectrum, and visual outcomes associated with acute-onset infectious endophthalmitis undergoing therapeutic pars plana vitrectomy.
Multicenter interventional retrospective noncomparative consecutive case series. Billing records were reviewed to identify all charts for patients undergoing pars plana vitrectomy within 14 days of diagnosis of acute-onset infectious endophthalmitis over a 4-year period at 5 large tertiary referral retina practices. Statistical analysis was performed to assess for factors associated with visual outcomes.
Seventy patients were identified. The most common clinical setting was postcataract surgery (n = 20). Only 3 patients (4.3%) presented with 20/400 or better visual acuity (VA). Although most of the patients initially underwent vitreous tap and intravitreal antibiotic injection (n = 47, 67.1%), all patients eventually underwent pars plana vitrectomy within 14 days of presentation with 68.5% (48/70) of patients undergoing pars plana vitrectomy within 48 hours of presentation. Positive intraocular cultures were obtained in 56 patients (80%). The most common identified organism was Streptococcus sp (n = 19). Visual acuity at last follow-up was 20/400 or better in 19 patients (27.1%). Three patients underwent evisceration or enucleation (4.3%). Last recorded postoperative VA (mean LogMAR 1.99 ± 0.94, Snellen VA equivalent finger count) improved from presenting VA (mean LogMAR 2.37 ± 0.38, Snellen VA hand motions) (P ≤ 0.001). There was no statistically significant correlation between the underlying etiology or the timing of surgery with this VA outcome.
Although less than one-third of patients achieved 20/400 or better VA, this VA often improved significantly from presenting VA.
报告接受治疗性玻璃体切割术的急性感染性眼内炎的临床表现、微生物谱及视力预后。
多中心干预性回顾性非对照连续病例系列研究。回顾计费记录，以确定在5家大型三级转诊视网膜专科机构4年期间内，诊断为急性感染性眼内炎后14天内接受玻璃体切割术的所有患者的病历。进行统计分析以评估与视力预后相关的因素。
共纳入70例患者。最常见的临床情况是白内障术后（n = 20）。仅有3例患者（4.3%）就诊时视力为20/400或更好。虽然大多数患者最初接受了玻璃体穿刺和玻璃体内抗生素注射（n = 47，67.1%），但所有患者最终均在就诊后14天内接受了玻璃体切割术，其中68.5%（48/70）的患者在就诊后48小时内接受了玻璃体切割术。56例患者（80%）眼内培养结果为阳性。最常见的病原体是链球菌属（n = 19）。末次随访时，19例患者（27.1%）视力为20/400或更好。3例患者接受了眼内容剜除术或眼球摘除术（4.3%）。末次记录的术后视力（平均LogMAR 1.99±0.94，Snellen视力相当于指数）较就诊时视力（平均LogMAR 2.37±0.38，Snellen视力相当于手动）有所改善（P≤0.001）。潜在病因或手术时机与该视力预后之间无统计学显著相关性。
虽然不到三分之一的患者视力达到20/400或更好，但该视力通常较就诊时视力有显著改善。
