万古霉素联合头孢他啶眼内注射防治外伤性眼内炎的效果观察

Vancomycin combined with ceftazidime intraocular injection for prevention and therapy of traumatic endophthalmitis

目的观察万古霉素注射液联合头孢他啶注射液眼内注射防治外伤性眼内炎的临床效果。方法本研究采用回顾性队列研究。收集南阳市眼科医院2017至2019年开放性眼外伤172例(172眼)患者作为观察组, 急诊行清创缝合联合头孢他啶注射液及万古霉素注射液眼内注射;另纳入2015年至2016年的开放性眼外伤患者78例(78眼)作为对照组, 急诊行清创缝合手术;观察两组患者术后7 d内眼内炎发生率及手术前后角膜内皮细胞密度、视力、眼压变化情况。结果观察组有2例(2眼)术后7 d内发生眼内炎, 发生率为1.16%(2/172), 对照组有19例(19眼), 发生率为24.36%(19/78);两组眼内炎发生率比较, 差异有统计学意义(χ^(2)=34.57, P<0.001)。观察组手术前后视力、眼压和角膜内皮细胞密度比较, 差异均无统计学意义(均P>0.05)。两组眼内炎患者眼内液经微生物培养, 微生物培养检出率52.38%(11/21)。经万古霉素联合头孢他啶眼内注射治疗后有7例症状消失, 5例经再次眼内注射万古霉素联合头孢他啶后症状消失, 9例因药物治疗无效最后行玻璃体视网膜手术。眼内注射的眼内炎控制率为57.14%(12/21)。结论万古霉素联合头孢他啶眼内注射防治外伤性眼内炎有效, 且对视力、眼压及角膜内皮细胞密度无影响。

Objective To observe the clinical efficacy of vancomycin combined with ceftazidime intraocular injection to prevent traumatic endophthalmitis.Methods This was a retrospective cohort study.A total of 172 eyes of 172 patients with open ocular trauma in Nanyang Eye Hospital from 2017 to 2019 were selected as the observation group.They received emergency debridement and suture combined with intraocular injection of ceftazidime and vancomycin.Seventy-eight eyes of 78 patients with open ocular trauma from 2015 to 2016 were selected as the control group,and they only underwent emergency debridement and suture.The incidence of endophthalmitis within 7 days after surgery was observed in the two groups,and the changes of corneal endothelial cell density,visual acuity and intraocular pressure before and after surgery.Results There were 2 eyes of 2 patients developed endophthalmitis within 7 days in the observation group,the incidence of endophthalmitis was 1.16%(2/172),and there were 19 eyes of 19 patients developed endophthalmitis within 7 days in the control group,the incidence of endophthalmitis was 24.36%(19/78).The difference in the incidence of endophthalmitis between the two groups was statistically significant(χ^(2)=34.57,P<0.001).There were no significant differences in visual acuity,intraocular pressure and corneal endothelial cell density before and after surgery(all P>0.05).The detection rate of microbial culture of intraocular fluid in patients with endophthalmitis was 52.38%(11/21).After intraocular injection of vancomycin combined with ceftazidime,7 cases were directly controlled,5 cases were controlled after re-injection of vancomycin combined with ceftazidime,9 patients received vitreoretinal surgery due to ineffective drug treatment.The control rate of endophthalmitis with intraocular injection was 57.14%(12/21).Conclusion Vancomycin combined with ceftazidime intraocular injection is effective in the prevention of traumatic endophthalmitis,and has no significant effect on visual acuity,intraocular pressure and corneal endothelial cell density.