Weber Constance, Stasik Isabel, Herrmann Philipp, Schmitz-Valckenberg Steffen, Holz Frank G, Liegl Raffael
Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany.
John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, University of Utah, Salt Lake City, UT 84132, USA.
J Clin Med. 2023 Aug 3;12(15):5097. doi: 10.3390/jcm12155097.
Early vitrectomy for postsurgical endophthalmitis may improve visual acuity outcomes. Silicone oil as a tamponade has some potential benefits in the management of endophthalmitis. This study aims to evaluate the use of a silicone oil tamponade in the surgical management of endophthalmitis. All patients with a pars plana vitrectomy with silicone oil tamponade for postsurgical endophthalmitis at the Department of Ophthalmology, University of Bonn, Germany, between 2017 and 2021 were retrospectively reviewed. We included all preoperative data, including BCVA at diagnosis, clinical findings, and symptoms. For every follow-up visit, we looked at BCVA and complications. In total, 82 patients were included in this study. The mean follow-up was 13.1 months (range 1-58 months). An intravitreal injection was the cause in 42 patients (51.2%) and cataract surgery in 29 patients (35.4%). The mean interval between the causing event and the date of onset was 8.8 days (range, 1-59 days). The most prevalent pathogen was Staphylococcus epidermidis in 16 patients (19.5%). In 47 patients (57.3%), no pathogen was found. The initial best-corrected visual acuity was 2.1 logMAR and improved significantly to 1.0 logMAR after six months ( < 0.001) and 1.1 logMAR after 1 year ( < 0.001). In a multivariate analysis, a low BCVA at diagnosis ( = 0.041) was a significant predictor for poor visual acuity outcomes. A total of 17 patients (20.1%) developed postoperative complications. Five patients (6.1%) needed an anterior chamber washout with repeated injections of antibiotics. Two patients (2.4%) had persistent fibrin and were treated with YAG-laser treatment. Three patients (6.7%) developed a retinal detachment. Two patients (2.4%) had persistent corneal decompensation with endothelial cell loss and received perforating keratoplasty. We performed a matched-pair analysis ( = 30, each group = 15) to compare a silicone oil tamponade with BSS at the end of surgery. The visual acuity outcome showed no significant differences (BCVA after one year: 1.17 logMAR in eyes with silicone oil and 0.90 logMAR in eyes with BSS; = 0.684). In our study, a vitrectomy with silicone oil tamponade in the surgical management of postoperative endophthalmitis led to a significant improvement in visual acuity and had a low complication rate. Low BCVA at diagnosis was significantly associated with poor visual acuity outcomes. A comparison of silicone oil and BSS at the end of surgery showed similar results.
早期玻璃体切除术治疗术后眼内炎可能会改善视力预后。硅油作为一种填塞物，在眼内炎的治疗中具有一些潜在益处。本研究旨在评估硅油填塞在眼内炎手术治疗中的应用。对2017年至2021年期间在德国波恩大学眼科接受玻璃体切除联合硅油填塞治疗术后眼内炎的所有患者进行了回顾性研究。我们纳入了所有术前数据，包括诊断时的最佳矫正视力（BCVA）、临床检查结果和症状。每次随访时，我们观察BCVA和并发症情况。本研究共纳入82例患者。平均随访时间为13.1个月（范围1 - 58个月）。42例患者（51.2%）病因是玻璃体内注射，29例患者（35.4%）病因是白内障手术。致病事件与发病日期之间的平均间隔为8.8天（范围1 - 59天）。最常见的病原体是表皮葡萄球菌，共16例患者（19.5%）。47例患者（57.3%）未发现病原体。初始最佳矫正视力为2.1 logMAR，6个月后显著改善至1.0 logMAR（<0.001），1年后为1.1 logMAR（<0.001）。多因素分析显示，诊断时BCVA较低（=0.041）是视力预后不良的显著预测因素。共有17例患者（20.1%）发生术后并发症。5例患者（6.1%）需要进行前房冲洗并反复注射抗生素。2例患者（2.4%）有持续性纤维蛋白，接受了YAG激光治疗。3例患者（6.7%）发生视网膜脱离。2例患者（2.4%）出现持续性角膜失代偿伴内皮细胞丢失，接受了穿透性角膜移植术。我们进行了配对分析（=30，每组=15），以比较手术结束时硅油填塞与平衡盐溶液（BSS）的效果。视力结果显示无显著差异（1年后BCVA：硅油填充眼为1.17 logMAR，BSS填充眼为0.90 logMAR；=0.684）。在我们的研究中，玻璃体切除联合硅油填塞治疗术后眼内炎可显著改善视力，且并发症发生率较低。诊断时BCVA较低与视力预后不良显著相关。手术结束时硅油与BSS的比较结果相似。
