白内障术后眼内炎的危险因素及临床分析

Risk Factor and Clinical Analysis of Endophthalmitis after Cataract Surgery

目的探讨白内障术后眼内炎的危险因素和临床表现及玻璃体切割术治疗术后眼内炎的预后。方法收集白内障术后6周内发生眼内炎并于我院行玻璃体切割术的患者25例。将全部患者依据白内障术前既往史中危险因素的有无,分为伴有危险因素组(A组)和不伴有危险因素组(B组),回顾性分析两组的临床表现及预后。结果两组的病原菌检出率分别为A组60%,B组66%。最终视力1.0以上的比例两组分别为10%和46%,A组显著低于B组(P<0.05)。A组的病原菌以耐甲氧西林金黄色葡萄球菌、溶血性链球菌和肠球菌居多。两组均有约70%的角膜切口出现术后切口闭合不全,且未被结膜覆盖的切口在A组中显著增多(P<0.05)。结论伴有危险因素的白内障术后眼内炎患者的视力预后不良,对此类患者行白内障手术时必须谨慎选择并制作切口。

Objective To study the risk factors and clinical features of endophthalmitis after cataract surgery,and to discuss the visual prognosis after vitrectomy for endophthalmitis. Methods This study was made on 25 eyes that underwent a vitrectomy for endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into 2 groups according to the presence （group A） or absence （group B） of risk factors, and the clinical features and prognosis were retrospectively compared. Results The culture-positive rate in group A and B was 60% and 66% ,respectively. The incidence of a final visual acuity of more than 1.0 was significantly lower in group A （ 10% ） than in group B （46%,P 〈 0.05）. Methicilhn-resistant staphylococcus aureus,hemolytic streptococcus and enterococcus were frequently de- tected in group A. Leakage from the cataract wound was found in about 70% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent in group A （P 〈 0.05）. Conclusion Postoperative endophthalmitis has a worse visual prognosis in patients with risk factors, so precise wound construction during cataract surgery is necessary in these patients.