Bacon A S, Davison C R, Patel B C, Frazer D G, Ficker L A, Dart J K
Moorfields Eye Hospital, London, UK.
Eye (Lond). 1993;7 ( Pt 4):529-34. doi: 10.1038/eye.1993.115.
Eleven cases of endophthalmitis occurring after vitreoretinal surgery are described. At Moorfields Hospital, London, from 1986 to 1990 the incidence of endophthalmitis after explant surgery with or without drain was 0.19% and after vitrectomy was 0.15%. We conclude that the parity may be due to the intraocular instrumentation of most conventional retinal detachment repair procedures. The best indicator of poor prognosis was speed of onset of symptoms, those with rapid evolution having the worst outcome; 2 of these cases were enucleated. Those presenting at 2-3 days had the best outcome, consistent with infection due to a less virulent organism. Delays in diagnosis were in part due to the posterior location of signs of infection. Potential risk factors amenable to prophylactic strategy were identified in 10 of the 11 patients. Supplementary prophylaxis using ciprofloxacin or imipenem is proposed for cases with an identifiable risk factor. After systemic administration these antibiotics achieve vitreous levels that exceed the MIC90 of the commonest causative pathogens.
本文描述了11例玻璃体视网膜手术后发生的眼内炎病例。在伦敦的摩尔菲尔德眼科医院，1986年至1990年期间，有或没有引流的植入物取出手术后眼内炎的发生率为0.19%，玻璃体切除术后为0.15%。我们得出结论，这种发生率相当可能是由于大多数传统视网膜脱离修复手术的眼内器械操作所致。预后不良的最佳指标是症状出现的速度，症状迅速发展的患者预后最差；其中2例眼球被摘除。在2 - 3天出现症状的患者预后最佳，这与毒性较低的病原体感染相符。诊断延迟部分是由于感染体征位于眼后部。11例患者中有10例确定了适合预防性策略的潜在危险因素。对于有可识别危险因素的病例，建议使用环丙沙星或亚胺培南进行补充预防。全身给药后，这些抗生素在玻璃体中的浓度超过了最常见致病病原体的MIC90。
