2004-2016年单中心光明工程白内障手术后急性感染性眼内炎的发病状况及预防措施探讨

Pathogenesis and Prevention of Postoperative Endophthalmitis after Cataract Surgery from 2004 to 2016 in the Single-Center of the Guangming Project

目的：分析光明工程白内障手术后急性感染性眼内炎的发病状况及影响因素，并探讨其预防措施。方法：回顾性系列病例研究。收集2004 年1 月至2016 年12 月间在金华眼科医院实施白内障光明工程手术且术后发生急性感染性眼内炎患者的临床资料，分析该并发症的发病率、临床特点及可能的诱因。分析不同术式、不同围手术期处理方式对该病发病率的影响。各不同情况发病率的比较采用Fisher确切概率法。结果：12 年间20 131 例白内障光明工程手术中，共发生术后急性感染性眼内炎16 例，发病率0.079%。其中小切口白内障囊外摘除联合人工晶状体（IOL）植入术5 371 例，发生术后急性感染性眼内炎2 例，发病率0.037%；透明角膜切口白内障超声乳化吸除联合IOL植入术14 760 例，发生术后急性感染性眼内炎14 例，发病率0.095%。两种手术方法术后急性感染性眼内炎的发病率差异无统计学意义。术前剪睫毛（发病率0.121%）与不剪睫毛（发病率0.062%）患者术后急性感染性眼内炎的发病率差异无统计学意义。术前以0.5%聚维酮碘冲洗结膜囊（发病率0.059%）与术前未冲洗（发病率0.174%）患者术后急性感染性眼内炎的发病率差异有统计学意义（P=0.04）。16 例术后急性感染性眼内炎患者中，4例男性患者有明确诱因，占总数的25%，其中1例患者在发病前1 d洗头；1例患者发病前1 d参与拆除自家房顶倒塌的旧墙；1例患者术后自购纱布盖眼，且7 d未更换；1例患者术后仅滴出院带药的其中一种滴眼液，且每天只点1次，余12例患者无明显诱因。另外在眼内炎玻璃体手术中发现2 例患者透明角膜主切口斜形，密闭性差。结论：白内障光明工程手术后急性感染性眼内炎发病率为0.079%。术前以0.5%聚维酮碘冲洗结膜囊可降低白内障术后眼内炎的发病率。加强宣教，避免术后可能引起眼部感染的不恰当举措及活动是减少光明工程白内障手术后感染性眼内炎发病率的重要措施。

Objective： To analyze the incidence and influencing factors of postoperative endophthalmitis after cataract surgery in the Guangming Project, and to recommend precautionary actions. Methods： In this retrospective study of cases from January 2004 to December 2016 in Jinhua Eye Hospital, we collected clinical data of cataract surgery patients who developed postoperative endophthalmitis. Then we analyzed the incidence,clinical features, and possible preventive measures. The effects of different surgical procedures and different perioperative management protocols were analyzed. The Fisher exactness test was used for statistical analysis. Results： Sixteen cases of postoperative endophthalmitis occurred after 20, 131 cataract surgeries during the study period; thus, the cumulative incidence was 0.079%. After 5, 371 cases of small incision extracapsular cataract extraction, there were two cases of postoperative endophthalmitis （0.037%）.After 14, 760 cases of phacoemulsification, there were 14 cases of postoperative endophthalmitis （0.095%）.There was no significant difference in the incidence of postoperative endophthalmitis between the two surgical methods （P=0.265）. There was also no difference in the incidence of postoperative endophthalmitis between procedures in which the eyelashes were trimmed （incidence 0.121%） or not trimmed （incidence 0.062%, P=0.29）. The incidence of postoperative endophthalmitis for patients using 0.5% povidone iodine to wash the conjunctival sac before surgery was 0.059%, while the incidence for patients not using the povidone wash was 0.174%, P=0.04）. According to the description of the cause of the disease, we found that 4 cases of male patients have a clear incentive, accounting for 25%, of which one patient shampoo a day before the disease occurring; one patient dismantle the old wall of its own roof collapse one day beforethe disease occurring; One patient covered surgery eye by their own buied gauze; One patient droped the surgery eye only with one of the discharged medicine, and only once a day. There were no obvious causes in the remaining 12 patients. In addition, follow-up intravitreal surgery found that the clear corneal incision was oblique and poorly closed in two patients. Conclusions： The incidence of postoperative endophthalmitis after cataract surgery is 0.079%. Pre-surgical washing of the conjunctival sac with 0.5% povidone iodine before the operation can reduce the incidence of postoperative endophthalmitis. The incidence of postoperative endophthalmitis can probably be further reduced by providing patients with clear pre- and postoperative medical and behavioral instructions to ensure that medications are taken properly, and that inappropriate activities are avoided.