玻璃体腔注射术后眼内炎的临床分析

Clinical analysis on endophthalmitis after intravitreal injection

目的:分析玻璃体腔注射术后眼内炎的发生并总结原因,旨在进一步提高手术安全性。方法:回顾性分析中国人民解放军总医院第六医学中心2010年9月至2019年11月行玻璃体腔注射术的421例患者(973眼)的术后1 d、1周、1个月的随访资料。归纳注射药物种类、注射病因、患者全身病史,总结术后眼内炎的发生及治疗情况。结果:玻璃体腔注射术安全性高,但严重并发症眼内炎(0.41%)仍偶有发生。4例眼内炎患者中2例为Irvine-Gass综合征患者行曲安奈德玻璃体腔注射后,1例为视网膜中央静脉阻塞患者行曲安奈德玻璃体腔注射后,1例为中心性渗出性视网膜脉络膜病变患者行雷珠单抗玻璃体腔注射后。其中曲安奈德引起的眼内炎(1.99%)明显高于抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物引起的眼内炎(0.12%)。结论:严格按照操作指南操作,当针对高血压老年群体尤其是Irvine-Gass综合征患者玻璃体腔注射曲安奈德时尤其防范眼内炎的发生。

Objective:To analyze the incidence and causes of endophthalmitis after intravitreal injection and to further improve the safety of the surgery.Methods:The follow-up data of 973 eyes of 421 patients who received intravitreal injection in our hospital in the past 9 years at 1 day,1 week and 1 month were retrospectively analyzed.The types of injected drugs,the cause of injection and systemic history were summarized,and the occurrence and treatment of postoperative endophthalmitis were summarized.Results:The intravitreal injections were safe.However,the severe complication of endophthalmitis(0.41%)occurred occasionally.Among these 4 patients with endophthalmitis,2 patients were intravitreal injected triamcinolone acetonide because of Irvine-Gass syndrome;1 patient accepted intravitreal injection by Ranibizumab because of central retinal vein occlusion;1 patient accepted intravitreal injection by Ranibizumab because of central exudative chorioretinopathy.The incidence of endophthalmitis(1.99%)after intravitreal injection of triamcinolone acetonide was higher than that of antivascular endothelial growth factor(VEGF)agents(0.12%).Conclusion:The clinical operating guideline of intravitreal injection should be followed strictly.Furthermore,the elderly people with hypertension diagnosed of Irvine-Gass syndrome have a higher risk of endophthalmitis after intravitreal injection of triamcinolone acetonide than others and should be paid more important attention.