Department of Ophthalmology, Duke Eye Center, Duke Hospital, Durham, North Carolina.
Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Ophthalmol Glaucoma. 2021 Mar-Apr;4(2):193-200. doi: 10.1016/j.ogla.2020.09.003. Epub 2020 Sep 12.
To describe the predisposing factors, presentation, management, and outcome of glaucoma drainage implant (GDI)-associated endophthalmitis.
Retrospective chart review.
Eyes that developed GDI-associated endophthalmitis between December 1, 2011, and December 23, 2019, at the Duke Eye Center and Cole Eye Institute.
Patient data search was performed on the basis of diagnostic codes for GDI and endophthalmitis. Endophthalmitis was defined clinically according to each physician's discretion. Eyes with infection source other than GDI were excluded. Worse vision was defined as a decrease of more than 2 Snellen lines. Data were collected on baseline demographics, systemic and ocular comorbidities, ocular surgical history, best-corrected visual acuity (BCVA), intraocular pressure (IOP), clinical presentation, eye culture results, and treatments performed. Statistical analysis included the paired t test and odds radio calculations.
Visual acuity and IOP at final follow-up.
Thirty cases (0.7%) of GDI endophthalmitis were identified among 4073 GDIs performed at the 2 institutions with active follow-up. Device exposure was identified in 20 eyes (67%) on presentation. The average follow-up after presentation was 22.4 ± 25 months. The most frequently identified organism on culture was Streptococcus pneumoniae. Same-day injection of intravitreal antibiotics was the universal first-line therapy. From baseline to final follow-up, the mean BCVA decreased from -0.84 ± 0.77 to -1.30 ± 0.93 (logarithm of the minimum angle of resolution, P = 0.02). Mean IOP did not change from baseline to final visit in the overall cohort (16.2 ± 8.2 mmHg to 14.6 ± 9.4 mmHg, P = 0.30) and in the subgroup that underwent tube explant (15.9 ± 5.5 mmHg to 15.2 ± 10.4 mmHg, P = 0.97). Eighteen of 20 tube exposure cases (90%) underwent tube explant, 1 underwent tube revision, and 1 re-epithelialized.
Glaucoma drainage implant-associated endophthalmitis was correlated with poor visual outcome. Immediate intravitreal antibiotic delivery was a universal first-line therapy. Tube exposure was a necessary risk factor for late-onset endophthalmitis and required surgical removal or repair.
描述青光眼引流植入物（GDI）相关眼内炎的易患因素、表现、治疗和结局。
回顾性图表审查。
2011 年 12 月 1 日至 2019 年 12 月 23 日期间，在杜克眼科中心和科尔眼科研究所接受 GDI 相关眼内炎治疗的患者。
根据 GDI 和眼内炎的诊断代码进行患者数据搜索。根据每位医生的判断，将眼内炎定义为临床感染。排除感染源非 GDI 的患者。视力下降定义为视力下降超过 2 行 Snellen 视力表。收集的基线人口统计学、全身和眼部合并症、眼部手术史、最佳矫正视力（BCVA）、眼内压（IOP）、临床表现、眼培养结果和治疗等数据。统计学分析包括配对 t 检验和比值比计算。
最终随访时的视力和眼压。
在 2 家机构进行的 4073 例 GDI 中，发现 30 例（0.7%）发生 GDI 眼内炎，均有活跃的随访。在就诊时，有 20 只眼（67%）发现器械暴露。就诊后平均随访时间为 22.4±25 个月。培养最常发现的病原体是肺炎链球菌。当天注射眼内抗生素是普遍的一线治疗方法。从基线到最终随访，平均 BCVA 从-0.84±0.77 降至-1.30±0.93（最小分辨角对数，P=0.02）。在整个队列中，平均 IOP 从基线到最终随访时没有变化（16.2±8.2mmHg 至 14.6±9.4mmHg，P=0.30），在接受引流管摘除术的亚组中也没有变化（15.9±5.5mmHg 至 15.2±10.4mmHg，P=0.97）。20 例引流管暴露病例中，18 例（90%）行引流管摘除术，1 例行引流管修复术，1 例重新上皮化。
青光眼引流植入物相关眼内炎与视力预后不良相关。立即给予眼内抗生素是普遍的一线治疗方法。引流管暴露是迟发性眼内炎的必要危险因素，需要手术切除或修复。
