Chen Yi-Hao, Chen Jiann-Torng, Tai Ming-Cheng, Chou Yu-Ching, Chen Ching-Long
Department of Ophthalmology, Tri-Service General Hospital School of Public Health, National Defense Medical Center, Taipei, Taiwan.
Medicine (Baltimore). 2017 Dec;96(49):e8941. doi: 10.1097/MD.0000000000008941.
Acute-onset endophthalmitis after cataract surgery is a rare but serious complication. In this study, we identified the clinical profile of acute-onset endophthalmitis after cataract surgery using a retrospective review between January 1, 2009 and December 31, 2015 at a referral center in northern Taiwan. Twenty-five eyes of 25 patients with endophthalmitis were included; 60% were male. The mean age at diagnosis was 70.44 ± 1.66 years. The right eye was affected in 44% of patients. The mean time of cataract surgery to hospital was 12.76 ± 1.88 days. The mean time from the onset of endophthalmitis to hospital was 3.72 ± 0.78 days. Furthermore, 56% of patients received the immediate treatment of an intracameral or intravitreal injection of antibiotics at a clinic before referral. The mean initial visual acuity was 1.97 ± 0.15 logarithm of the minimum angle of resolution. The initial examination found corneal edema in 84% of patients, hypopyon in 48%, and vitritis in 88%. A total of 76% of patients underwent an initial treatment of pars plana vitrectomy and intraocular antibiotic injection (IOAI); 24% received an IOAI. The culture results of 52% (13/25) of patients were positive; 4 isolates were gram-positive, 8 were nontuberculosis Mycobacterium abscessus, and 1 was fungal. Thirteen of 25 patients had hypertension; 2 of 25 had diabetes mellitus. The mean follow-up time was 61.64 ± 8.27 days. Multiple factors influenced the final visual outcome of acute-onset endophthalmitis after cataract surgery. This study found that early referral for treatment could improve the final outcome. In addition, postcataract endophthalmitis caused by M abscessus recurs easily and has a worse visual outcome despite appropriate treatment.
白内障手术后急性发作的眼内炎是一种罕见但严重的并发症。在本研究中，我们通过对2009年1月1日至2015年12月31日期间台湾北部一家转诊中心的病例进行回顾性分析，确定了白内障手术后急性发作眼内炎的临床特征。纳入了25例患有眼内炎患者的25只眼；其中60%为男性。诊断时的平均年龄为70.44±1.66岁。44%的患者右眼受累。白内障手术至入院的平均时间为12.76±1.88天。眼内炎发作至入院的平均时间为3.72±0.78天。此外，56%的患者在转诊前于诊所接受了前房或玻璃体内注射抗生素的即时治疗。初始平均视力为最小分辨角对数的1.97±0.15。初始检查发现84%的患者有角膜水肿，48%有前房积脓，88%有玻璃体炎。共有76%的患者接受了初始的玻璃体切割术和眼内抗生素注射（IOAI）治疗；24%接受了眼内抗生素注射。52%（13/25）患者的培养结果呈阳性；4株为革兰氏阳性菌，8株为非结核分枝杆菌脓肿，1株为真菌。25例患者中有13例患有高血压；25例中有2例患有糖尿病。平均随访时间为61.64±8.27天。多种因素影响白内障手术后急性发作眼内炎的最终视力结果。本研究发现早期转诊治疗可改善最终结果。此外，由脓肿分枝杆菌引起的白内障后眼内炎尽管进行了适当治疗，但仍容易复发且视力结果较差。
