Doft B H, Kelsey S F, Wisniewski S R
Retina-Vitreous Consultants, Pittsburgh, Pennsylvania, USA.
Ophthalmology. 1998 Apr;105(4):707-16. doi: 10.1016/s0161-6420(98)94028-3.
The study aimed to assess the frequency, indications, and outcome of additional ocular procedures after initial treatment of vitrectomy (VIT) or tap-biopsy (TAP) for patients with endophthalmitis after cataract extraction.
The study design was an analysis of observational data collected as part of a multicenter, randomized clinical trial.
Of the 420 patients enrolled in the Endophthalmitis Vitrectomy Study, the 148 who had additional procedures were compared with the 272 who did not.
The types, indications, and number of additional ocular procedures were assessed. A masked examiner measured visual acuity 9 to 12 months after study entry.
Within 1 week of study entry, 8% of VIT eyes and 13% of TAP eyes underwent additional procedures, 14% for complications of the initial procedure and 86% for worsening ocular inflammation or infection. Cultures were obtained in 33 of the 38 eyes operated on for worsening inflammation or infection and were positive in 42%. Cultures obtained from the early additional procedures were positive more frequently in eyes with an initial TAP (71%) than in eyes with an initial VIT (13%). Both virulence of initial microbiologic organism isolated and poor presenting vision were risk factors for requirement of reoperation. In all cases in which a single organism was cultured at the initial procedure, when the reculture was positive, it was the same organism. Late additional procedures (after 7 days) were required in 27% of patients. Visual outcome was much worse for eyes that had an additional procedure compared to eyes that did not, and this was especially the case for eyes that had an early additional procedure. Only 15% of eyes that had an early additional procedure achieved 20/40 visual acuity as compared to 57% of eyes that did not.
Need for an additional procedure was a marker of more severe disease, and patients who underwent additional procedures achieved poorer visual acuity at final follow-up.
本研究旨在评估白内障摘除术后眼内炎患者在初次接受玻璃体切割术（VIT）或穿刺活检（TAP）治疗后进行额外眼科手术的频率、适应证及手术结果。
本研究设计为对作为多中心随机临床试验一部分收集的观察性数据进行分析。
在参与眼内炎玻璃体切割术研究的420例患者中，将148例接受额外手术的患者与272例未接受额外手术的患者进行比较。
评估额外眼科手术的类型、适应证及数量。一名盲态检查者在研究入组9至12个月后测量视力。
在研究入组1周内，8%的接受玻璃体切割术的眼和13%的接受穿刺活检的眼接受了额外手术，其中14%是由于初次手术的并发症，86%是由于眼部炎症或感染恶化。在因炎症或感染恶化而接受手术的38眼中，33眼进行了培养，42%呈阳性。从早期额外手术中获得的培养物在初次接受穿刺活检的眼中阳性率更高（71%），高于初次接受玻璃体切割术的眼（13%）。初次分离出的微生物的毒力和较差的初始视力都是再次手术的危险因素。在初次手术培养出单一微生物的所有病例中，再次培养呈阳性时，为同一种微生物。27%的患者需要进行晚期额外手术（7天后）。与未接受额外手术的眼相比，接受额外手术的眼的视觉结果要差得多，早期接受额外手术的眼尤其如此。早期接受额外手术的眼中只有15%达到了20/40的视力，而未接受额外手术的眼中这一比例为57%。
需要进行额外手术是疾病更严重的一个标志，接受额外手术的患者在最终随访时视力较差。
