Palexas G N, Green W R, Goldberg M F, Ding Y
Eye Pathology Laboratory, Wilmer Ophthalmological Institute, Johns Hopkins Medical Institutions, Baltimore, USA.
Trans Am Ophthalmol Soc. 1995;93:281-308; discussion 308-14.
To review the experience of diagnostic pars plana vitrectomies (PPV).
The authors reviewed 405 consecutive diagnostic PPV's performed between November 1973 and October 1994.
Diagnostic vitrectomy was performed in 215 (53%) of 405 eyes for suspected endophthalmitis. Of those 215 cases, acute inflammation was confirmed in 62 (28.8%), 60 (27.9%) had microbial organisms present and 36 (16.7%) were culture-positive. Microbial organisms were observed microscopically in 31 (20%) of 156 patients suspected of postoperative endophthalmitis. Of those 31 cases, 23 (74%) were gram-positive, eleven (37%) of 30 eyes had organisms associated with glaucoma filtering procedures and 20 (16%) of 126 eyes had organisms with non-filtering procedures. The pooled percentage of eyes that developed postoperative endophthalmitis as a complication during the period July 1990 thru June 1994 is 5 (0.046%) out of a heterogeneous group of 10,898 cases operated on at the Wilmer Eye Institute for cataract, glaucoma, corneal transplant, pars plana vitrectomy and retinal detachment. Bacteria were identified microscopically in 6 (18%) of 34 post-traumatic cases. Microbial organisms were identified in 23 (92%) of 25 cases with an endogenous infection. Patients with endogenous infections had the most fungal infections, and the majority were in males. Neoplasms were diagnosed in 58 (14%) of the 405 cases. The most common neoplasm was ocular lymphoma 42 (72%), 69% of which were in females. Only 42 (48.3%) of 87 patients clinically suspected of having ocular lymphoma, actually had ocular lymphoma. Those negative for lymphoma were significantly older (67.4 +/- 10 years) compared to those with lymphoma (60.4 +/- 14 years) (P = 0.01).
Diagnostic PPV has proved to be valuable in confirming and establishing various clinical diagnoses.
回顾经平坦部玻璃体切除术（PPV）的诊断经验。
作者回顾了1973年11月至1994年10月期间连续进行的405例诊断性PPV。
405眼中有215眼（53%）因怀疑眼内炎而进行了诊断性玻璃体切除术。在这215例病例中，62例（28.8%）确诊为急性炎症，60例（27.9%）发现有微生物，36例（16.7%）培养呈阳性。在156例疑似术后眼内炎的患者中，31例（20%）在显微镜下观察到微生物。在这31例病例中，23例（74%）为革兰氏阳性菌，30眼中有11例（37%）的微生物与青光眼滤过手术有关，126眼中有20例（16%）的微生物与非滤过手术有关。在1990年7月至1994年6月期间，威尔默眼科研究所对10898例白内障、青光眼、角膜移植、经平坦部玻璃体切除术和视网膜脱离患者进行了手术，其中作为并发症发生术后眼内炎的患者合并百分比为5例（0.046%）。在34例创伤后病例中，6例（18%）在显微镜下发现细菌。25例内源性感染病例中有23例（92%）发现微生物。内源性感染患者真菌感染最多，且大多数为男性。405例病例中有58例（14%）诊断为肿瘤。最常见的肿瘤是眼淋巴瘤42例（72%），其中69%为女性。临床怀疑患有眼淋巴瘤的87例患者中，只有42例（48.3%）实际患有眼淋巴瘤。淋巴瘤阴性患者（67.4±10岁）比淋巴瘤阳性患者（60.4±14岁）年龄显著更大（P = 0.01）。
诊断性PPV已被证明在确认和确立各种临床诊断方面具有价值。
