Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand.
Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
Br J Ophthalmol. 2022 Aug;106(8):1145-1149. doi: 10.1136/bjophthalmol-2020-316846. Epub 2021 Mar 12.
To examine the role of early vitrectomy in the management of endophthalmitis from all causes.
Retrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200).
Median age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes.
Early vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.
研究各种病因所致眼内炎的早期玻璃体切除术的作用。
对奥克兰地区卫生局 2006 年 1 月 1 日至 2019 年 7 月 31 日期间诊断为眼内炎的 290 例连续患者进行回顾性研究。主要观察指标为 9 个月随访时的视力和严重视力丧失（≤20/200）的患者比例。
患者中位年龄为 70.4 岁，女性 151 例（52.1%）。白内障手术是 92 例（31.7%）患者发生眼内炎的最常见原因，其次是玻璃体腔内注射 57 例（19.7%）、内源性眼内炎 48 例（16.6%）、非手术性外伤 42 例（14.5%）、青光眼手术 24 例（8.3%）、玻璃体切除术 22 例（7.6%）和角膜手术 5 例（1.7%）。136 例（46.9%）培养阳性，以革兰氏阳性菌最常见（76.5%）。82 例（28.3%）患者行早期玻璃体切除术。9 个月时的中位视力为 20/100（20/30 至光感），严重视力丧失发生率为 100 例（43.5%）。视网膜脱离 35 只眼（12.1%），26 只眼行眼球摘除术。多变量分析显示，年龄较小、就诊时视力较差和培养阳性的眼内炎与较差的预后相关，而早期玻璃体切除术与较好的预后相关。
早期玻璃体切除术（24 小时内）与 9 个月时的视觉预后更好相关，而年龄较小、就诊时视力较差和培养阳性的眼内炎与较差的视力预后相关。
