Robbins Cason B, Feng Henry L, Gupta Divakar, Fekrat Sharon
Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.
J Vitreoretin Dis. 2020 Sep 17;5(2):130-134. doi: 10.1177/2474126420953963. eCollection 2021 Mar-Apr.
Clinical presentation, treatment choices, and outcomes in cases of bleb-related endophthalmitis (BRE) at a tertiary care center over a 9-year period are described.
A retrospective review was conducted of patients diagnosed with BRE at Duke Eye Center (Durham, North Carolina) from January 1, 2009 to January 1, 2018, with at least 6 months of follow-up, assessing demographic data, initial management, and visual acuity (VA).
Twenty eyes of 20 patients with BRE were identified. Median time from surgery to presentation was 6.53 years. Presenting VA of light perception only was significantly associated with the decision to pursue pars plana vitrectomy (PPV) as initial treatment (odds ratio 59.4, 95% CI, 2.1-1670.8, = .016). Twelve eyes (60%) had culture-proven infectious endophthalmitis. Eleven eyes (55%) underwent PPV during treatment; 5 eyes underwent PPV on presentation, and 6 eyes underwent PPV after initial presentation. Compared with pre-endophthalmitis VA, 6 eyes that underwent subsequent PPV had greater VA loss at 6 months than cases not undergoing subsequent PPV (Early Treatment Diabetic Retinopathy Study line loss of 14 vs 4 lines, respectively; = .044).
BRE eyes presenting with light-perception VA were more likely to undergo initial PPV; yet many eyes in this study required PPV during treatment. Visual outcomes are often poor in BRE despite intensive management. There was greater VA loss from pre-endophthalmitis VA levels at 6 months in eyes undergoing PPV after initial treatment. Prospective studies are needed to assess the optimal role of PPV in patients with BRE.
描述一家三级医疗中心9年间与滤过泡相关的眼内炎（BRE）病例的临床表现、治疗选择及预后。
对2009年1月1日至2018年1月1日在杜克眼科中心（北卡罗来纳州达勒姆）诊断为BRE且随访至少6个月的患者进行回顾性研究，评估人口统计学数据、初始治疗及视力（VA）。
确定了20例BRE患者的20只眼。从手术到发病的中位时间为6.53年。仅光感的初始视力与选择玻璃体切割术（PPV）作为初始治疗显著相关（优势比59.4，95%可信区间，2.1 - 1670.8，P = 0.016）。12只眼（60%）经培养证实为感染性眼内炎。11只眼（55%）在治疗期间接受了PPV；5只眼在发病时接受了PPV，6只眼在初次发病后接受了PPV。与眼内炎前的视力相比，6只随后接受PPV的眼在6个月时的视力损失比未接受后续PPV的病例更大（糖尿病视网膜病变早期治疗研究视力下降分别为14行和4行；P = 0.044）。
初始视力仅为光感的BRE眼更有可能接受初始PPV；然而本研究中的许多眼在治疗期间需要PPV。尽管进行了强化治疗，BRE的视力预后通常较差。初始治疗后接受PPV的眼在6个月时相对于眼内炎前的视力水平有更大的视力损失。需要进行前瞻性研究以评估PPV在BRE患者中的最佳作用。
