Bhende Muna, Raman Rajiv, Jain Mukesh, Shah Pratik K, Sharma Tarun, Gopal Lingam, Bhende Pramod S, Srinivasan Sangeetha, Jambulingam Malathi
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
L & T Microbiology Research Centre, Vision Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India.
PLoS One. 2018 Jan 16;13(1):e0191173. doi: 10.1371/journal.pone.0191173. eCollection 2018.
To describe the incidence, risk factors, clinical presentation, causative organisms, and outcomes in patients with endophthalmitis following pars plana vitrectomy (20G and minimally invasive vitrectomy surgery (MIVS).
Of 111,876 vitrectomies (70,585 20-G 41,291 MIVS) performed, 45 cases developed acute-onset, postoperative endophthalmitis.
The rate of culture positive and culture negative endophthalmitis was 0.021% (2.1/10,000 surgeries) and 0.019% (1.9/10,000 surgeries) overall, 0.031% (3.1/10,000 surgeries) and 0.025% (2.5/10,000 surgeries) in 20G, and 0.005% (0.5/10,000 surgeries) and 0.007% (0.7/10,000 surgeries) in the MIVS group respectively. Potential predisposing factors were as follows: diabetes, 46.7%; vitrectomy for vascular retinopathies, 44.4%; and vitrectomy combined with anterior segment surgeries, 35.5%. The culture proven rates were 53.3% overall, 55.0% for 20G and 40.0% for MIVS. The most common organism was Pseudomonas aeruginosa for 20G. Klebsiella and Staphylococcus aureus were isolated in the two culture positive cases in MIVS group. The follow-up period for the patients with endophthalmitis was 586.14 ± 825.15 days. Seven were lost to follow up beyond one week. Of the remaining 38, 13 (34.2%) cases had a favorable visual outcome (i.e., best-corrected visual acuity [BCVA] > 5/200) and 24 (63.2%) had unfavorable visual outcome (BCVA < 5/200). Group with culture test results negative had significantly better outcomes (P < 0.05) as compared to those with positive.
MIVS does not increase the risk of endophthalmitis. Outcomes are poor despite appropriate treatment, particularly in cases with culture results positive.
描述经睫状体平坦部玻璃体切除术（20G和微创玻璃体切除术[MIVS]）后眼内炎患者的发病率、危险因素、临床表现、致病微生物及预后情况。
在111,876例玻璃体切除术中（70,585例20G手术，41,291例MIVS手术），45例发生急性术后眼内炎。
总体上，培养阳性和培养阴性眼内炎的发生率分别为0.021%（2.1/10,000例手术）和0.019%（1.9/10,000例手术）；20G手术中分别为0.031%（3.1/10,000例手术）和0.025%（2.5/10,000例手术）；MIVS组分别为0.005%（0.5/10,000例手术）和0.007%（0.7/10,000例手术）。潜在的易感因素如下：糖尿病，46.7%；因视网膜血管病变行玻璃体切除术，44.4%；玻璃体切除术联合眼前节手术，35.5%。总体培养证实率为53.3%，20G手术为55.0%，MIVS手术为40.0%。20G手术中最常见的微生物是铜绿假单胞菌。MIVS组的2例培养阳性病例分离出肺炎克雷伯菌和金黄色葡萄球菌。眼内炎患者的随访期为586.14±825.15天。7例在随访1周后失访。其余38例中，13例（34.2%）视力预后良好（即最佳矫正视力[BCVA]>5/200），24例（63.2%）视力预后不良（BCVA<5/200）。培养结果为阴性的组与阳性组相比，预后明显更好（P<0.05）。
MIVS不会增加眼内炎的风险。尽管进行了适当治疗，但预后较差，尤其是培养结果为阳性的病例。
