Greenfield D S, Suñer I J, Miller M P, Kangas T A, Palmberg P F, Flynn H W
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami (Fla) School of Medicine, USA.
Arch Ophthalmol. 1996 Aug;114(8):943-9. doi: 10.1001/archopht.1996.01100140151007.
To identify the incidence, causative organisms, and clinical outcomes of eyes with bleb-associated endophthalmitis after glaucoma filtering procedures with adjunctive mitomycin.
Retrospective analysis of 773 consecutive eyes that underwent glaucoma filtering surgery at the Bascom Palmer Eye Institute, Miami, Fla. The course of 609 eyes from 485 patients with a minimum of 3 months of follow-up were reviewed.
Mean follow-up was 16.0 +/- 11.5 months (range, 3-48 months). Of the 609 eyes, 13 (2.1%) developed bleb-associated endophthalmitis an average of 18.5 +/- 13.2 months after surgery (range, 1-45 months). The incidence of bleb-associated endophthalmitis was significantly greater after inferior trabeculectomy (7.8% per patient-year) than after superior trabeculectomy (1.3% per patient-year) by Kaplan-Meier estimates (P = .02, log rank test). The cumulative incidence was 13% for inferior limbal blebs and 1.6% for superior limbal blebs. Nine (69.2%) of the 13 eyes were culture positive. Streptococcus sanguis and Haemophilus influenzae (6/13 [46.2%]) were the most frequent causative organisms. The mean increase in intraocular pressure after endophthalmitis treatment was 1.2 mm Hg, with a mean decrease in visual acuity of 1.42 logMAR units. Eight (61.5%) of the 13 eyes had a final acuity of 20/400 or better.
The incidence of bleb-associated endophthalmitis after guarded filtering surgery performed with adjunctive mitomycin is higher than the reported rate in eyes undergoing filtering surgery without the use of antifibrotic agents (0.2%-1.5%). Inferior limbal trabeculectomy carries the highest risk of infection. Eyes with mitomycin blebs maintained excellent filtration capacity. However, after treatment of the infection, the visual outcomes were generally poor.
确定青光眼滤过手术联合丝裂霉素治疗后与滤过泡相关的眼内炎的发生率、致病微生物及临床结局。
对佛罗里达州迈阿密市巴斯科姆帕尔默眼科研究所连续接受青光眼滤过手术的773只眼进行回顾性分析。对485例患者的609只眼进行了至少3个月的随访，并对其病程进行了回顾。
平均随访时间为16.0±11.5个月（范围3 - 48个月）。在609只眼中，13只（2.1%）在术后平均18.5±13.2个月（范围1 - 45个月）发生了与滤过泡相关的眼内炎。根据Kaplan-Meier估计，小梁切除术下方发生与滤过泡相关眼内炎的发生率（每年7.8%）显著高于小梁切除术上方（每年1.3%）（P = 0.02，对数秩检验）。下方角膜缘滤过泡的累积发生率为13%，上方角膜缘滤过泡为1.6%。13只眼中有9只（69.2%）培养阳性。血链球菌和流感嗜血杆菌（6/13 [46.2%]）是最常见的致病微生物。眼内炎治疗后眼压平均升高1.2 mmHg，视力平均下降1.42 logMAR单位。13只眼中有8只（61.5%）最终视力达到20/400或更好。
青光眼滤过手术联合丝裂霉素治疗后与滤过泡相关的眼内炎发生率高于未使用抗纤维化药物的滤过手术报道率（0.2% - 1.5%）。下方角膜缘小梁切除术感染风险最高。使用丝裂霉素的滤过泡眼维持了良好的滤过能力。然而，感染治疗后，视觉结局通常较差。
