Wu Xia-Ni, Chen Yi-Hsing, Sharief Lazha, Al-Janabi Ahmed, Al Qassimi Nura, Lightman Sue, Tomkins-Netzer Oren
NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK.
Institute of Ophthalmology, University College London, London EC1V 9EL, UK.
Antibiotics (Basel). 2022 Jun 23;11(7):843. doi: 10.3390/antibiotics11070843.
Background: Examining the effect of antibiotic resistance, use of intravitreal antibiotics and systemic corticosteroids on visual outcome of eyes with acute endophthalmitis. Methods: We included 226 eyes with acute endophthalmitis, treated using a standardized protocol. Visual outcome up to 12 months was assessed related to biopsy results, antibiotics resistance and treatment regimens. Results: Vitreous biopsies were more likely to be culture-positive (41.1%) than anterior chamber biopsies (21.6%, p < 0.0001). Antibiotic resistance for amikacin was found in 19 eyes (24.7%), vancomycin in 29 eyes (31.5%) and moxiflocacin in 14 eyes (16.1%). At presentation 91.53% of eyes had BCVA < 20/40, reducing by 1 month to 69.94% (p < 0.0001) and remaining stable at 12 months. There was no difference in visual outcome for those receiving early systemic corticosteroids. Endophthalmitis following cataract surgery (OR 1.66, 1.04−2.66 95% CI, p = 0.03) and receiving intravitreal vancomycin (OR 3.15, 1.18−8.42 95% CI, p = 0.02) were associated with a greater chance of final BCVA ≥ 20/40. Conclusion: Using vitreous taps with intravitreal antibiotics, despite an increase in resistance to both vancomycin and moxifloxacin, results in a final BCVA > 20/200 in half of eyes and ≥20/40 in a third. Early treatment with intravitreal antibiotics should not be delayed.
研究抗生素耐药性、玻璃体内注射抗生素及全身使用糖皮质激素对急性眼内炎患者视力预后的影响。方法：纳入226例采用标准化方案治疗的急性眼内炎患者。评估至12个月时的视力预后与活检结果、抗生素耐药性及治疗方案的关系。结果：玻璃体活检培养阳性率（41.1%）高于前房活检（21.6%，p<0.0001）。发现19例（24.7%）对阿米卡星耐药，29例（31.5%）对万古霉素耐药，14例（16.1%）对莫西沙星耐药。就诊时91.53%的患者最佳矫正视力（BCVA）<20/40，1个月时降至69.94%（p<0.0001），12个月时保持稳定。早期接受全身糖皮质激素治疗的患者视力预后无差异。白内障手术后发生眼内炎（比值比[OR]1.66，95%置信区间[CI]1.04 - 2.66，p = 0.03）及接受玻璃体内注射万古霉素（OR 3.15，95%CI 1.18 - 8.42，p = 0.02）的患者最终BCVA≥20/40的可能性更大。结论：使用玻璃体内注射抗生素进行玻璃体穿刺取材，尽管对万古霉素和莫西沙星的耐药性增加，但仍有半数患者最终BCVA>20/200，三分之一患者最终BCVA≥20/40。不应延迟早期玻璃体内注射抗生素治疗。
