Duke University School of Medicine, Durham, North Carolina.
Duke Eye Center, Duke University, Durham, North Carolina.
Ophthalmol Retina. 2021 Apr;5(4):324-329. doi: 10.1016/j.oret.2020.07.027. Epub 2020 Aug 1.
To investigate the impact of time from symptom onset to presentation on the clinical course and outcomes of eyes with endophthalmitis.
Retrospective, longitudinal cohort study.
One hundred thirty-three eyes of 130 patients with endophthalmitis.
Adults diagnosed with endophthalmitis at the Duke Eye Center from January 1, 2009, through January 1, 2018, were identified using the Duke Enterprise Data Unified Content Explorer. Patient demographics, time of symptom onset, presenting clinical features, management, and outcomes were recorded by retrospective review. Patients were divided into those seeking medical care either early (within 2 days) or later (delayed, i.e., 3 days or longer) with regard to symptom onset. Clinical features, management, and visual outcomes of eyes with early or delayed presentation were compared.
Mean corrected visual acuity (VA) at presentation and at 6 months.
In eyes with delayed presentation, VA was significantly worse on initial examination (delayed, 20/2941 vs. early, 20/1124; P = 0.009) and at 6 months (delayed, 20/547 vs. early, 20/173; P = 0.01). When controlling for time to presentation, VA before endophthalmitis was correlated significantly with VA at 6 months (Pearson r = 0.55; R = 29%; P < 0.0001). Eyes with glaucoma drainage device-related endophthalmitis were more likely to have a delayed presentation (P = 0.03). Eyes with delayed presentation were more likely to have conjunctival injection on initial examination (delayed, 73% vs. early, 52%; P = 0.01). Visual acuity before endophthalmitis, pain, and patient-reported blurred vision were not associated with early or delayed presentation (P > 0.05).
Delayed presentation was associated with worse VA on initial examination and at 6 months in eyes with endophthalmitis. Presence of pain did not prompt earlier presentation. Visual acuity before endophthalmitis was associated with VA at 6 months, regardless of time to presentation. Further investigation may help to improve anticipatory guidelines for at-risk patients.
研究从症状出现到就诊的时间对眼内炎临床过程和结局的影响。
回顾性、纵向队列研究。
2009 年 1 月 1 日至 2018 年 1 月 1 日期间在杜克眼科中心诊断为眼内炎的 130 例 133 只眼的患者。
使用 Duke 企业数据统一内容资源管理器，确定患有眼内炎的成人患者。通过回顾性审查记录患者的人口统计学特征、症状出现时间、就诊时的临床特征、治疗方法和结局。根据症状出现时间，将患者分为早期（2 天内）和晚期（延迟，即 3 天或更长时间）就诊。比较早期和晚期就诊的眼部的临床特征、治疗方法和视力结局。
就诊时和 6 个月时的平均矫正视力（VA）。
在晚期就诊的眼中，初始检查时 VA 明显更差（晚期，20/2941 与早期，20/1124；P=0.009），6 个月时也更差（晚期，20/547 与早期，20/173；P=0.01）。在控制就诊时间后，在眼内炎之前的 VA 与 6 个月时的 VA 显著相关（Pearson r=0.55；R=29%；P<0.0001）。与青光眼引流装置相关的眼内炎更可能出现延迟就诊（P=0.03）。晚期就诊的眼中，初始检查时结膜充血更常见（晚期，73%与早期，52%；P=0.01）。在眼内炎之前的 VA、疼痛和患者自述视力模糊与早期或晚期就诊均无相关性（P>0.05）。
眼内炎患者中，就诊延迟与初始检查和 6 个月时 VA 更差有关。疼痛的存在并未促使更早就诊。在眼内炎之前的 VA 与 6 个月时的 VA 相关，而与就诊时间无关。进一步的研究可能有助于改善高危患者的预期指导方针。
