Soliman Mohamed K, Gini Giampoalo, Kuhn Ferenc, Iros Mariano, Parolini Barbara, Ozdek Sengul, Michalewska Zofia, Bopp Silvia, Adelman Ron A, Sallam Ahmed B
Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Ophthalmology, University of Ottawa, Ottawa, Canada.
Southampton University Hospital NHS Trust, Southampton, United Kingdom.
Ophthalmol Retina. 2019 Jun;3(6):461-467. doi: 10.1016/j.oret.2019.03.009. Epub 2019 Mar 21.
To study the practice patterns for the management of acute postoperative and postinjection endophthalmitis.
Retrospective, interventional, nonrandomized, multicenter study.
Data on 237 eyes diagnosed with acute endophthalmitis occurring after intraocular surgery or procedures provided by 57 retina specialists from 28 countries.
Rates of pars plana vitrectomy (PPV), repeat intravitreal injection, and adjunctive therapeutic regimens (local and systemic antibiotics and steroids).
Of 237 analyzed eyes, acute endophthalmitis secondary to cataract surgery or secondary lens implantation represented 64.6% of cases (153 eyes), whereas the remaining were secondary to intravitreal injections (35 eyes [14.8%]), PPV (29 eyes [12.2%]), and other intraocular surgeries (20 eyes [8.4%]). All eyes received intravitreal antibiotics on the same day of diagnosis. Overall, early PPV was used within the first week of presentation in 176 eyes (74.3%). There was no statistical difference in the proportion of eyes requiring a second intravitreal injection of antibiotics whether the eye was managed primarily with intravitreal antibiotics alone versus early PPV plus intravitreal antibiotics (29.5% [18 eyes] vs. 25.0% [44 eyes], respectively). Adjunctive therapies in the form of intravitreal steroids, systemic steroids, and systemic antibiotics were used in 25.3%, 21.9%, and 66.6% of eyes, respectively. The absence of disc or macular view and absence of endophthalmitis after cataract surgery were associated with an increased likelihood for early PPV (odds ratios 4.1 and 5.1, respectively).
Pars plana vitrectomy was frequently performed regardless of the presenting vision in eyes with endophthalmitis after cataract surgery and intravitreal injections. Increased vitreous opacification was associated with a higher probability for performing PPV.
研究急性术后及注射后眼内炎的治疗模式。
回顾性、干预性、非随机、多中心研究。
来自28个国家的57位视网膜专家提供的237只诊断为眼内手术后或操作后发生急性眼内炎的眼睛的数据。
玻璃体切割术（PPV）、重复玻璃体内注射以及辅助治疗方案（局部和全身使用抗生素及类固醇）的发生率。
在237只分析的眼中，白内障手术或二期晶状体植入后继发的急性眼内炎占病例的64.6%（153只眼），其余继发于玻璃体内注射（35只眼[14.8%]）、PPV（29只眼[12.2%]）和其他眼内手术（20只眼[8.4%]）。所有眼睛在诊断当天均接受了玻璃体内抗生素治疗。总体而言，176只眼（74.3%）在发病第一周内接受了早期PPV。无论眼睛主要是单纯接受玻璃体内抗生素治疗还是早期PPV加玻璃体内抗生素治疗，需要第二次玻璃体内注射抗生素的眼睛比例无统计学差异（分别为29.5%[18只眼]和25.0%[44只眼]）。分别有25.3%、21.9%和66.6%的眼睛使用了玻璃体内类固醇、全身类固醇和全身抗生素形式的辅助治疗。白内障手术后无视盘或黄斑可见以及无眼内炎与早期PPV的可能性增加相关（优势比分别为4.1和5.1）。
白内障手术和玻璃体内注射后发生眼内炎的眼睛，无论初始视力如何，均频繁进行玻璃体切割术。玻璃体混浊增加与进行PPV的可能性更高相关。
