Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA.
Eye (Lond). 2021 Jul;35(7):1850-1858. doi: 10.1038/s41433-021-01462-9. Epub 2021 Mar 5.
Glaucoma drainage device (GDD)-related endophthalmitis is a devastating complication of device implantation. There are no guidelines in the literature to assist clinicians in deciding if the GDD should be explanted or if patients require pars plana vitrectomy (PPV). This study compares the outcomes of GDD explantation with device retention and also independently compares the outcomes of PPV versus intravitreal antibiotics alone in patients with GDD-related endophthalmitis. A literature search for studies discussing GDD-related endophthalmitis from 2005 to 2019 was performed; 30 articles were included. The visual acuity/anatomical outcomes were compared between GDD explantation and retention, and between patients that received a PPV and those that did not. These outcomes were combined with a medical records review of 13 patients with GDD-related endophthalmitis from an academic institution. A total of 88 eyes were included. 70.5% underwent GDD explantation, while 37.8% received a PPV. GDD explantation was associated with a lower rate of evisceration/enucleation when compared to GDD retention (4.8% versus 19.2%, OR 0.22, 95% CI 0.05-1.01, p = 0.05), but visual acuity outcomes were similar. No eyes that received an immediate vitrectomy became phthisic or required evisceration/enucleation, compared an evisceration/enucleation rate of 15.2% in eyes treated solely with intravitreal antibiotics (OR 1.18, 95% CI 1.04-1.33, p = 0.04). Explantation of the GDD and immediate vitrectomy are both associated with better anatomical outcomes in GDD-related endophthalmitis. Further research is needed to provide more definitive guidelines in the ideal management of these patients.
青光眼引流装置（GDD）相关眼内炎是装置植入后的一种破坏性并发症。目前文献中尚无指南可帮助临床医生决定是否应将 GDD 取出，或者患者是否需要行玻璃体切除术（PPV）。本研究比较了 GDD 取出与保留装置的结果，并比较了 GDD 相关眼内炎患者接受 PPV 与单独玻璃体腔内抗生素治疗的结果。对 2005 年至 2019 年讨论 GDD 相关眼内炎的研究进行了文献检索，共纳入 30 篇文章。比较了 GDD 取出与保留、接受 PPV 与未接受 PPV 的患者的视力/解剖学结果。这些结果与一家学术机构的 13 例 GDD 相关眼内炎患者的病历回顾相结合。共纳入 88 只眼。70.5%的患者行 GDD 取出术，37.8%的患者行 PPV。与保留 GDD 相比，GDD 取出术的眼内容剜除/眼球摘除率较低（4.8%比 19.2%，OR 0.22，95%CI 0.05-1.01，p=0.05），但视力结果相似。立即行玻璃体切除术的眼无一例发生眼球萎缩或需要眼内容剜除/眼球摘除，而单纯玻璃体腔内抗生素治疗的眼的眼内容剜除/眼球摘除率为 15.2%（OR 1.18，95%CI 1.04-1.33，p=0.04）。GDD 取出和立即玻璃体切除术均与 GDD 相关眼内炎的更好的解剖学结果相关。需要进一步的研究为这些患者的理想治疗提供更明确的指南。
