患者特征和手术相关风险因素对白内障手术后眼内炎的影响：一项荟萃分析。

Impact of Patient Characteristics and Surgery-Related Risk Factors on Endophthalmitis after Cataract surgery: A Meta-Analysis.

作者信息

Zhang Shanshan, Xu Jian

机构信息

Department of Ophthalmology, Qingdao Eighth People's Hospital, Qingdao, China.

Department of Ophthalmology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.

出版信息

Ophthalmic Res. 2025;68(1):117-136. doi: 10.1159/000543353. Epub 2025 Jan 7.

DOI:10.1159/000543353

PMID:39773547

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11844714/

Abstract

INTRODUCTION

Cataracts are the leading cause of blindness worldwide, with a notably high incidence rate. Endophthalmitis is the most severe complication following cataract surgery, often resulting in profound vision loss. This study evaluates the impact of risk factors such as age, sex, diabetes mellitus (DM), hypertension, posterior capsule rupture (PCR), type of surgery, and use of intraocular lens (IOL) material on the risk of endophthalmitis after cataract surgery.

METHODS

English and Chinese public databases were searched from inception to March 1, 2024. We included studies reporting the number of occurrences of endophthalmitis after cataract surgery on potential risk factors, including age, sex, DM status, hypertension status, intraoperative PCR, type of surgery and use of IOL material. The quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 57 studies were included and critically evaluated in the meta-analysis. The results showed that female sex was associated with a lower risk of endophthalmitis (odds ratio [OR]: 0.81; 95% CI: 0.75-0.87; p < 0.001). Individuals with diabetes who underwent cataract surgery were found to have a greater risk of endophthalmitis (I2 = 95%; OR: 4.90; 95% CI: 2.41, 9.95; p < 0.001), but the result may be influenced by publication bias. Individuals with hypertension (OR: 2.88; 95% CI: 1.53, 5.45; p = 0.001) and intraoperative PCR (OR: 9.18; 95% CI: 3.31, 25.43; p < 0.001) were found to have a greater risk of endophthalmitis. Phacoemulsification significantly reduced the risk of endophthalmitis compared with extracapsular cataract extraction (ECCE) (OR: 0.62; 95% CI: 0.45, 0.85) based on network meta-analysis.

CONCLUSION

Male sex, hypertension, intraoperative PCR, and the use of the ECCE surgical approach are associated with a greater risk of postoperative endophthalmitis. Although an age-related trend in elevated risk was observed, this finding should be interpreted cautiously.

摘要

引言

白内障是全球失明的主要原因，发病率显著较高。眼内炎是白内障手术后最严重的并发症，常导致严重视力丧失。本研究评估年龄、性别、糖尿病（DM）、高血压、后囊破裂（PCR）、手术类型和人工晶状体（IOL）材料等危险因素对白内障手术后眼内炎风险的影响。

方法

检索英文和中文公共数据库，时间跨度从建库至2024年3月1日。我们纳入了报告白内障手术后眼内炎发生次数与潜在危险因素关系的研究，这些危险因素包括年龄、性别、糖尿病状态、高血压状态、术中后囊破裂、手术类型和人工晶状体材料的使用。采用纽卡斯尔-渥太华量表评估纳入研究的质量。

结果

共有57项研究纳入荟萃分析并进行严格评估。结果显示，女性发生眼内炎的风险较低（比值比[OR]：0.81；95%置信区间[CI]：0.75 - 0.87；p < 0.001）。接受白内障手术的糖尿病患者发生眼内炎的风险更高（I2 = 95%；OR：4.90；95% CI：2.41，9.95；p < 0.001），但该结果可能受发表偏倚影响。高血压患者（OR：2.88；95% CI：1.53，5.45；p = 0.001）和术中后囊破裂患者（OR：9.18；95% CI：3.31，25.43；p < 0.001）发生眼内炎的风险更高。基于网络荟萃分析，与白内障囊外摘除术（ECCE）相比，超声乳化术显著降低了眼内炎的风险（OR：0.62；95% CI：0.45，0.85）。