玻璃体切除术后感染性眼内炎相关因素分析

Factors Associated with Postvitrectomy Endophthalmitis

目的研究玻璃体切除术后发生医源性感染的相关因素,更好地预防与控制玻璃体切除术后感染。方法对2003-2007年玻璃体切除术后并发感染性眼内炎病例进行回顾性分析。结果共计施行14011例(眼)玻璃体切除手术,其中感染性眼内炎7例(眼),感染率为0.047%;7例标本送检,4例培养阳性,病原菌检出率57.0%;革兰阳性球菌占75.0%,>60岁患者占71.4%,6例抗感染治疗有效,预后较好;1例细菌培养为革兰阴性杆菌,为糖尿病患者,经抗感染,再次玻璃体切除治疗无效,行眼内容剜出术。结论玻璃体切除术后感染性眼内炎主要病原菌为革兰阳性球菌,术后眼内炎的发生与年龄大及合并全身疾病,机体免疫力低下关系密切,及时有效的抗感染治疗对保存和挽救视力非常重要。

OBJECTIVE To investigate factors associated with postvitrectomy endophthalmitis. METHODS Cases with postvitrectomy endophthalmitis in our hospital between 2003 and 2007 were collected and retrospectively reviewed. RESULTS All 14011 cases （eyes） underwent pars plana vitrectomy and postoperative endophthalmitis happened to seven cases （eyes）. The incidence of infection was 0. 047%. Confirmed microbiology was demonstrated in 4 of 7 cases （57.0%）, in which Gram-positive cocci were found 75.0%. 71.4% Of cases with postvitreetomy endophthalmitis were older than 60. The infection was controlled in 6 cases after antibiotic treatment. One case with diabetes and culture confirmation of Gram-negative bacilli deteriorated even after the second vitrectomy, and evisceration was finally performed. CONCLUSIONS The predominant organism is Gram-positive cocci in postvitreetomy endophthalmitis. The risk factors include increasing age, presence of systemic diseases and immunodeficiency. Timely and effective antibiotic therapy is important to restore visual acuity for postvitrectomy endophthalmitis.