早期玻璃体内注射抗生素对玻璃体切除术治疗外因性眼内炎疗效的影响

Early intravitreal injection of antibiotics to the curative effects of vitrectomy for exogenous endophthalnlitis

目的探讨眼内炎的手术治疗方法及早期玻璃体内注射抗生素对玻璃体切除术治疗外因性眼内炎疗效的影响。设计回顾性病例对照研究。研究对象北京同仁医院2000年1月至2004年12月收治的外因性眼内炎患者94例(94眼)。方法全部患者均在确诊眼内炎后不同时间行常规三通道玻璃体切除术。其中46眼在发现眼内炎后先行玻璃体内注射抗生素,在注药后3-14天(平均5．6天)行玻璃体切除术(Ⅰ组),其余48眼则直接行玻璃体切除术(Ⅱ组)。随访3-12个月(平均7．5个月), 观察患者的视力等术后情况。主要指标视力。结果 94眼术后视力较术前明显提高(P=0．000),其中Ⅰ组治疗有效率优于Ⅱ组 (P=0．029),进一步分析表明在明确眼内炎后7日内即进行玻璃体切除术者无论其术前是否行玻璃体注药术,治疗的有效率差异元统计学意义(P=0．692),但在7天以上者则两组治疗的有效率差异有统计学意义(P=0．008)。结论尽早行玻璃体切除术是治疗外因性眼内炎的有效方法,对于不能尽早施术者,在手术前及时行玻璃体内注射抗生素能明显提高治疗效果。

Objective To investigate the surgical treatment and early intravitreal injection of antibiotics to the curative effects of vitrectomy for exogenous endophthalmitis. Design Retrospective case-controlled study. Participants From Jan 2000 to Dec 2004, 94 patients（94 eyes）, diagnosed as endophthalmitis were evaluated retrospectively. Methods All patients underwent pars plana vitrectomy. 46 patients（46 eyes） underwent the intravitreal injection of antibiotics early before undergoing vitrectomy from 3 to 14 days（mean 5.6 days）（group Ⅰ ）. The other 48 patients（48 eyes） underwent vitrectomy directly（group Ⅱ ）. Postoperative follow-up ranged from 3 to 12 months （mean 7.5 months）. Main Outcome Measures Visual acuity. Results The visual acuities of these 94 patients improved significantly after vitrectomy （P=0.000）. The rate of curative effects in group I was significantly higher than that of the group Ⅱ （P=0.029）. According to the further analysis, the rates of curative effects of the patients underwent vitrectomy in 7 days were similar between group Ⅰand group 11 （P=0.692）, but the rates of curative effects of the patients underwent vitrectomy after 7 days were obviously different between two groups （P=0.008）. Conclusions Undergoing vitrectomy as early as possible is a good available method for the treatment of exogenous endophthalmitis. If the vitrectomy can not be undergone early, intravitreal injection of antibiotics in time before vitrectomy may increase the therapeutic effect of exogenous endophthalmitis obviously.