Eye Unit, Southampton University Hospital, Southampton, UK.
Eye Unit, St Thomas' Hospital, London, UK.
Surv Ophthalmol. 2018 Sep-Oct;63(5):677-693. doi: 10.1016/j.survophthal.2018.02.003. Epub 2018 Feb 15.
Management of postoperative bacterial endophthalmitis was explored in the Endophthalmitis Vitrectomy Study in 1995, which has underpinned the core protocols in treatment ever since. While surgical techniques have continued to evolve, little has changed in the overall clinical management as no further large randomized controlled trials have taken place. We review the literature addressing the incidence of endophthalmitis, pathogens, antibiotic therapies, and the role of vitrectomy. We suggest an update to management protocols based on available evidence. While vitreous culture remains the gold standard for diagnosis, new techniques allow bacterial identification after antibiotic administration, so injection should be initiated immediately. Current antibiotic regimes are comprehensive and do not need changing. Intravitreal antibiotics should not be repeated at 48 hours after initial treatment. Vitrectomy should be considered instead if the clinical picture is not improving.
1995 年的眼内炎玻璃体切除术研究探索了术后细菌性眼内炎的治疗方法，自此之后该研究成为了治疗的核心方案。虽然手术技术不断发展，但由于没有进行更多的大型随机对照试验，整体临床管理几乎没有改变。我们回顾了关于眼内炎发病率、病原体、抗生素治疗以及玻璃体切除术作用的文献。我们根据现有证据提出了管理方案的更新建议。虽然玻璃体培养仍然是诊断的金标准，但新的技术允许在抗生素治疗后进行细菌鉴定，因此应立即开始注射。目前的抗生素方案全面，无需更改。初次治疗后 48 小时不应重复玻璃体内注射抗生素。如果临床症状没有改善，应考虑进行玻璃体切除术。
