Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
Department of Ophthalmology, Zealand University Hospital, Næstved, Denmark.
JAMA Ophthalmol. 2023 Nov 1;141(11):1075-1078. doi: 10.1001/jamaophthalmol.2023.4637.
Since bilateral simultaneous postoperative endophthalmitis (BSPOE) after immediate sequential bilateral cataract surgery (ISBCS) can be devastating for the patient, evaluating such cases in depth is important to maintaining patient safety.
To evaluate whether a systemic breach of sterility was associated with an outbreak of BSPOE after ISBCSs performed on the same day at a single community-based eye clinic.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series included all patients diagnosed with BSPOE at ophthalmology departments in Denmark following an infectious outbreak after ISBCSs performed at a single community-based eye clinic in December 2022.
Bilateral simultaneous postoperative endophthalmitis acquired after ISBCS.
Patient recovery from BSPOE after ISBCS was evaluated based on clinical and microbiological reports.
A woman aged 71 years, a man aged 84 years, and a woman aged 79 years consecutively presented with symptoms of endophthalmitis at regional eye departments 4 to 8 days after ISBCS performed on the same date at the same eye clinic. Five of 6 infected eyes underwent vitrectomy, and all eyes received an intravitreous injection of antibiotics. The same strain of Staphylococcus epidermidis was isolated in 4 of 5 eyes that underwent vitrectomy. Contamination of viscoelastics was ruled out with repeated cultures. One eye was eviscerated due to phthisis. In another patient, the final visual acuity of the eye most severely affected was 20/63 Snellen equivalents. Visual acuity of the remaining eyes recovered to 20/25 (3 eyes in 2 patients) and 20/20 (1 eye) Snellen equivalents.
The finding of the same strain of S epidermidis in all patient cultures suggests a systemic breach of sterility at the clinic on the day of ISBCS. The outcome of these cases emphasizes the need to adhere to a strict surgical methodology and sterile principles during ISBCS.
由于双眼同期术后眼内炎（BSPOE）在双眼立即序贯白内障手术后（ISBCS）后可能对患者造成严重影响，因此深入评估此类病例对于维护患者安全至关重要。
评估在一家社区眼科诊所同一天进行的 ISBCS 后，是否存在全身性无菌性突破与 BSPOE 爆发有关。
设计、地点和参与者：本回顾性病例系列纳入了 2022 年 12 月在丹麦一家社区眼科诊所发生传染性爆发后，在丹麦各眼科部门诊断出患有 BSPOE 的所有患者。
双眼同期术后眼内炎是在 ISBCS 后获得的。
根据临床和微生物学报告评估 ISBCS 后 BSPOE 患者的恢复情况。
一名 71 岁女性、一名 84 岁男性和一名 79 岁女性相继在 ISBCS 同一天在同一家眼科诊所进行后，在区域眼科部门出现眼内炎症状，时间为 4 至 8 天。5 只受感染的眼中有 4 只进行了玻璃体切除术，所有眼均接受了玻璃体内抗生素注射。在 4 只接受玻璃体切除术的眼中分离出了相同的表皮葡萄球菌株。通过重复培养排除了黏弹剂污染。一只眼因眼球痨而被剜除。另一名患者中，受影响最严重的眼的最终视力为 20/63 标准视力表。其余 3 只眼（2 名患者）和 1 只眼的视力恢复至 20/25 和 20/20。
所有患者培养物中分离出相同的表皮葡萄球菌株表明，在 ISBCS 当天，诊所存在全身性无菌性突破。这些病例的结果强调了在 ISBCS 期间需要严格遵守手术方法和无菌原则。
