玻璃体切除术联合眼内抗生素治疗严重外伤性眼内炎的疗效。

EFFICACY OF VITRECTOMY COMBINED WITH INTRAVITREAL ANTIBIOTICS FOR SEVERE POST-TRAUMATIC ENDOPHTHALMITIS.

机构信息

Eye Hospital of Shandong First Medical University, Jinan, Shandong, China.

School of Ophthalmology, Shandong First Medical University, Jinan, Shandong, China; and.

出版信息

Retina. 2023 Nov 1;43(11):2003-2009. doi: 10.1097/IAE.0000000000003887.

DOI:10.1097/IAE.0000000000003887

PMID:37490780

Abstract

PURPOSE

To explore clinical efficacy of vitrectomy combined with intravitreal antibiotics in treating severe endophthalmitis after open-globe trauma in patients.

METHODS

The records of all patients who received vitrectomy combined with intravitreal for the severe post-traumatic endophthalmitis with light perception or worse between 2010 and 2022 were retrospectively reviewed. Patients received vitrectomy combined with intravitreal antibiotics, repeated intravitreal antibiotics with or without vitreous aspiration, and retinal repair after the infection was controlled. Efficacy of severe post-traumatic endophthalmitis was analyzed.

RESULTS

One hundred and twenty-one patients (121 eyes) were included in this study. The mean BCVA improved from 4.03 ± 0.18 logarithm of the minimum angle of resolution to 1.75 ± 1.41 logarithm of the minimum angle of resolution ( P < 0.001) at the end of the follow-up period, which increased in 106 eyes (87.60%). Infection was successfully controlled in all eyes, 88 eyes within two operations. Pathogens including streptococci (odds ratio [OR] = 6.68, P < 0.001), fungi (OR = 15.23, P < 0.001), and mixed infection (OR = 6.67, P < 0.05) were related to the number of operations. Finally, 60 eyes (49.59%) received silicone oil filling, 25 received gas tamponade, and the remaining 36 received no tamponade; complete vitrectomy was performed in all eyes with intraocular tamponade. All eyes for gas tamponade and no tamponade had been remained stable without retinal detachment and proliferative vitreoretinopathy after 6-month follow-up. The rate of recurrent retinal detachment after silicone oil tamponade was 4.96% (six eyes), including 1.65% (two eyes) of proliferative vitreoretinopathy; these eyes underwent reoperation of retinal detachment repair.

CONCLUSION

Vitrectomy combined with intravitreal antibiotics may be an effective treatment option for severe post-traumatic endophthalmitis.

摘要

目的

探讨玻璃体切除术联合眼内抗生素治疗眼外伤后严重眼内炎的临床疗效。

方法

回顾性分析 2010 年至 2022 年间 121 例（121 只眼）外伤后严重眼内炎患者行玻璃体切除术联合眼内抗生素治疗的临床资料。患者均经抗感染治疗后行玻璃体切除术联合眼内抗生素，反复眼内注药，必要时行玻璃体切割术联合硅油填充或气体填充。分析严重眼外伤后眼内炎的治疗效果。

结果

所有患者随访结束时最佳矫正视力（BCVA）由术前的 4.03±0.18 对数视力提高至 1.75±1.41 对数视力（P<0.001），其中 106 只眼（87.60%）视力提高。所有患者感染均得到有效控制，88 只眼 2 次手术控制感染，3 次手术控制感染 33 只眼。术前培养阳性患者中，葡萄球菌（比值比[OR] =6.68，P<0.001）、真菌（OR=15.23，P<0.001）、混合感染（OR=6.67，P<0.05）与手术次数有关。术后最终行硅油填充 60 只眼（49.59%），行气体填充 25 只眼，未行任何眼内填充 36 只眼。所有眼内有填充物的患者均行完全玻璃体切割术。随访 6 个月后，行气体填充和未行眼内填充的患者视网膜均未见脱离及增生性玻璃体视网膜病变。硅油填充患者中有 4.96%（6 只眼）发生视网膜脱离复发，其中 1.65%（2 只眼）发生增生性玻璃体视网膜病变，再次行视网膜脱离复位术。