Morlet N, Gatus B, Coroneo M
Department of Ophthalmology, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
Aust N Z J Ophthalmol. 1998 Feb;26(1):5-12. doi: 10.1046/j.1440-1606.1998.00072.x.
Although peri-operative prophylaxis to prevent endophthalmitis is commonly practised by ophthalmologists, no one method has clearly been demonstrated to be more effective than another. We surveyed 570 Fellows of the Royal Australian College of Ophthalmologists to determine what their methods of prophylaxis were and whether these differed for patients who developed endophthalmitis.
The questionnaire asked about the types of antibiotics and other methods of prophylaxis used before, during and after cataract surgery. Of those who reported cases of endophthalmitis, we asked specifically about the methods of prophylaxis used for those patients.
The response was 89% and the incidence of endophthalmitis was calculated as 0.11%. There was little difference in the methods of prophylaxis used by those who reported endophthalmitis compared with others, but pre-operative antibiotics were used more commonly by those who reported the disease (P = 0.06). Surgeons who had practised for 20 years or more reported a lower rate of endophthalmitis than others, as did those who performed more than 300 cataract operations per year. However the pattern of prophylaxis used by these two sub-groups was quite divergent. Differences in the methods of prophylaxis had no bearing on the development of endophthalmitis, with the exception that subconjunctival antibiotics were used less often in those patients who developed the disease (P = 0.03).
The results of the present study provide no clear answer regarding appropriate peri-operative prophylaxis. The wide range of prophylactic regimens used suggests that no one method is superior to another. Formal case-controlled studies are required to identify which method would be most efficacious.
尽管眼科医生普遍采用围手术期预防措施来预防眼内炎，但尚无一种方法被明确证明比另一种更有效。我们对570名澳大利亚皇家眼科医学院的研究员进行了调查，以确定他们的预防方法，以及这些方法在发生眼内炎的患者中是否有所不同。
问卷询问了白内障手术前、手术期间和手术后使用的抗生素类型及其他预防方法。对于那些报告发生眼内炎病例的人，我们专门询问了针对这些患者所采用的预防方法。
回复率为89%，眼内炎的发生率计算为0.11%。报告发生眼内炎的人与其他人相比，在预防方法上几乎没有差异，但报告发生眼内炎的人更常用术前抗生素（P = 0.06）。从业20年或更长时间的外科医生报告的眼内炎发生率低于其他人，每年进行超过300例白内障手术的医生也是如此。然而，这两个亚组所采用的预防模式差异很大。预防方法的差异与眼内炎的发生无关，只是发生眼内炎的患者较少使用结膜下抗生素（P = 0.03）。
本研究结果并未就适当的围手术期预防措施给出明确答案。所采用的预防方案范围广泛，这表明没有一种方法优于另一种。需要进行正式的病例对照研究来确定哪种方法最有效。
