House Robert J, Rotruck Jill C, Enyedi Laura B, Wallace David K, Saleh Ezzeldin, Freedman Sharon F
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
J AAPOS. 2019 Feb;23(1):26.e1-26.e7. doi: 10.1016/j.jaapos.2018.09.007. Epub 2019 Jan 3.
To identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes.
An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery.
Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P < 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n = 5 [38%]), previous skin or ear infection (n = 4 [31%]), and acute or chronic rhinitis (n = 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n = 3 [23%]), methicillin-sensitive S. aureus (n = 3 [23%]), and Streptococcus pyogenes/group-A Streptococcus (n = 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified.
A unifying explanation for the increase in post-strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age <18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.
在一家大型转诊中心识别并分析斜视手术后的感染病例，并报告其发生率、危险因素及结局。
通过电子数据库检索，确定了1996年7月至2017年10月在杜克眼科中心进行的斜视手术。使用眼周感染的诊断编码进一步识别斜视手术后可能感染的患者。
在9111例斜视手术中，13例（0.14%）符合可能感染的标准，均发生于2012年10月之后（之前6580例中0例，之后2531例中有13例[0.51%]；P<0.0001）。感染病例的平均年龄为11.4岁；11例患者（85%）年龄小于18岁。相关的既往诊断包括伴有发育迟缓的遗传异常（n=5[38%]）、既往皮肤或耳部感染（n=4[31%]）以及急性或慢性鼻炎（n=3[23%]）。感染部位培养显示耐甲氧西林金黄色葡萄球菌（n=3[23%]）、甲氧西林敏感金黄色葡萄球菌（n=3[23%]）和化脓性链球菌/A组链球菌（n=2[15%]）。仅1例为双侧感染。所有病例感染均局限于眼外，但有1只眼因视神经萎缩而失去光感。未发现与手术医生/手术/准备相关的常见风险因素。
未找到杜克眼科中心斜视手术后感染增加的统一解释。潜在危险因素包括年龄<18岁、发育迟缓、免疫功能低下、先前的非眼部感染和细菌定植。
