Waheed S, Liebmann J M, Greenfield D S, Ritterband D C, Seedor J A, Shah M, Ritch R
Department of Ophthalmology, New York Eye and Ear Infirmary, New York 10003, USA.
Br J Ophthalmol. 1998 Aug;82(8):926-9. doi: 10.1136/bjo.82.8.926.
To report the patient characteristics, causative organisms, and clinical outcomes in patients with recurrent bleb related ocular infections.
The medical records of all patients diagnosed with bleb related ocular infection at the New York Eye and Ear Infirmary over a 10 year period were reviewed. Recurrent bleb infection was defined as at least two episodes of bleb purulence with or without associated intraocular inflammation separated by a quiescent period of at least 3 months.
Recurrent bleb infections developed in 12 eyes of 12 patients (10 men, two women) a mean of 16.3 (SD 17.9) months (range 3-51 months) after the initial infection. Two patients developed a third episode 3 and 20 months, respectively, after the second infection, yielding a total of 14 recurrent infection episodes. Recurrent infection developed after trabeculectomy in 11 eyes (adjunctive 5-fluorouracil, nine eyes; mitomycin C, one eye; no antifibrosis agent, one eye) and following cataract extraction with inadvertent bleb formation in one eye. Four (36.4%) of the filtered eyes had undergone trabeculectomy at the inferior limbus. The mean follow up time from filtering surgery to the first bleb related infection was 28 months for the nine patients treated with 5-fluorouracil and 14 months for the single patient treated with mitomycin C. 11 (78.6%) cases had a documented bleb leak in the 4 week period before or at the time of recurrent infection. Topical, prophylactic antibiotics had been used in 7/14 (50%) cases. The same organism was cultured from the initial and recurrent infections in 2/14 (14.3%) cases.
Eyes that have been successfully treated for bleb related infection remain at risk for recurrent infection. No apparent correlation exists between organisms responsible for the initial and recurrent infections. The increased rate of recurrent bleb related infection in patients receiving adjunctive 5-fluorouracil compared to mitomycin C may have been related to the longer follow up of the 5-fluorouracil eyes.
报告复发性滤泡相关眼部感染患者的特征、致病微生物及临床结局。
回顾纽约眼耳医院10年间所有诊断为滤泡相关眼部感染患者的病历。复发性滤泡感染定义为至少两次滤泡化脓发作，伴或不伴有相关眼内炎症，发作间隔至少3个月的静止期。
12例患者（10例男性，2例女性）的12只眼发生复发性滤泡感染，初次感染后平均16.3（标准差17.9）个月（范围3 - 51个月）。2例患者在第二次感染后分别于3个月和20个月出现第三次发作，共14次复发性感染发作。11只眼在小梁切除术后发生复发性感染（辅助使用5 - 氟尿嘧啶9只眼；丝裂霉素C 1只眼；未使用抗纤维化药物1只眼），1只眼在白内障摘除术后意外形成滤泡后发生感染。接受小梁切除术的滤过眼中，4只（36.4%）位于下睑缘。接受5 - 氟尿嘧啶治疗的9例患者从滤过手术到首次滤泡相关感染的平均随访时间为28个月，接受丝裂霉素C治疗的1例患者为14个月。11例（78.6%）病例在复发性感染前4周内或感染时记录有滤泡渗漏。7/14（50%）例使用过局部预防性抗生素。2/14（14.3%）例初次感染和复发性感染培养出相同微生物。
成功治疗滤泡相关感染的眼仍有复发性感染风险。初次感染和复发性感染的致病微生物之间无明显相关性。与丝裂霉素C相比，接受辅助5 - 氟尿嘧啶治疗的患者复发性滤泡相关感染率增加可能与5 - 氟尿嘧啶治疗眼的随访时间较长有关。
