Sjoholm-Gomez de Liano Carl, Soberon-Ventura Vidal F, Salcedo-Villanueva Guillermo, Santos-Palacios Abril, Guerrero-Naranjo Jose Luis, Fromow-Guerra Jans, García-Aguirre Gerardo, Morales-Canton Virgilio, Velez-Montoya Raul
Retina Department, Asociación para Evitar la Ceguera en Mexico, Hospital "Dr. Luis Sanchez Bulnes" IAP, Mexico City, Mexico.
Universidad Popular Autonoma del Estado de Puebla, Puebla, Mexico.
Eye Vis (Lond). 2017 Jul 11;4:18. doi: 10.1186/s40662-017-0083-9. eCollection 2017.
To assess the sensitivity, specificity, positive predictive value and negative predictive value of anterior chamber tap for the diagnosis of bacterial endophthalmitis on a population with high prevalence.
Retrospective, single centre, case series study. We reviewed all medical records with clinical diagnosis of bacterial endophthalmitis in our hospital from January 1st, 2000 to December 31st 2014. From each record, we documented general demographic data, best corrected visual acuity and vitreous and aqueous tap microbiological results. All cases were further divided according to the endophthalmitis aetiology to perform individual calculations of sensitivity, specificity, positive predictive value, negative predictive value, accuracy and prevalence. We used the results of the vitreous tap as the gold standard for diagnosis of bacterial endophthalmitis. We excluded those records in which the aqueous and vitreous samples were not taken simultaneously or had an incomplete microbiological report. Significance were assessed with chi squared statistics, with an alpha value of 0.05 for statistical significance.
A total of 190 cases fulfilled the inclusion/exclusion criteria. Positive culture rate from vitreous samples was 64.74%. Positive culture rate from aqueous sample was 32.11%. Bacteria isolated from aqueous samples matched those isolated from vitreous samples 78.68% of the time. The overall sensitivity was 38.21%, specificity: 75.51%, positive predictive value: 79.66%, negative predictive value: 32.74% ( = 0.08). Subgroup analysis showed that anterior chamber taps in cases of post-surgical endophthalmitis had a moderate to low sensitivity (37.73%), high specificity (93%) and high positive predictive value (95%) ( < 0.04).
The sensitivity and specificity of anterior chamber tap are low and should not be used for critical therapeutic decisions in patients with suspected bacterial endophthalmitis. In cases of post-surgical endophthalmitis, the result of an anterior chamber tap could be used for therapeutic guidance, but only in conjunction with clinical presentation and in the absence of a better method for diagnosis.
评估前房穿刺术在高患病率人群中诊断细菌性眼内炎的敏感性、特异性、阳性预测值和阴性预测值。
回顾性、单中心病例系列研究。我们查阅了我院2000年1月1日至2014年12月31日所有临床诊断为细菌性眼内炎的病历。从每份病历中，我们记录了一般人口统计学数据、最佳矫正视力以及玻璃体和房水穿刺的微生物学结果。所有病例根据眼内炎病因进一步分组，以分别计算敏感性、特异性、阳性预测值、阴性预测值、准确性和患病率。我们将玻璃体穿刺结果作为诊断细菌性眼内炎的金标准。我们排除了房水和玻璃体样本未同时采集或微生物学报告不完整的病历。采用卡方统计评估显著性，显著性水平α值为0.05。
共有190例符合纳入/排除标准。玻璃体样本的阳性培养率为64.74%。房水样本的阳性培养率为32.11%。从房水样本中分离出的细菌与从玻璃体样本中分离出的细菌匹配的时间为78.68%。总体敏感性为38.21%，特异性为75.51%，阳性预测值为79.66%，阴性预测值为32.74%（P = 0.08）。亚组分析显示，手术后眼内炎病例的前房穿刺敏感性中等至低（37.73%），特异性高（93%），阳性预测值高（95%）（P < 0.04）。
前房穿刺的敏感性和特异性较低，不应将其用于疑似细菌性眼内炎患者的关键治疗决策。在手术后眼内炎病例中，前房穿刺结果可用于治疗指导，但仅结合临床表现且在没有更好诊断方法的情况下使用。
