摘要
目的 评价玻璃体腔注射万古霉素治疗眼内炎的有效性和安全性,为临床决策提供参考。方法计算机检索PubMed、EMbase、Cochrane Library、ClinicalTrials. gov、CNKI、万方数据库及NTIS、SIGLE两个灰色文献数据库,收集关于玻璃体腔注射万古霉素治疗眼内炎的有效性和安全性的临床研究,检索时限均从建库至2022年4月25日。由2位评价员按纳入与排除标准独立筛选文献、提取资料并评价质量后,采用定性分析方法描述研究结果。结果 最终纳入1篇队列研究,4篇病例系列研究。队列研究应用万古霉素球内注射治疗眼内容炎16例,与庆大霉素球内注射疗法18例进行了病例对照观察。两组治疗有效率相似,但显效率万古霉素组为50.0%,庆大霉素组为16.7%,差异有统计学意义(P<0.05)。4篇病例系列研究,研究疾病均为外源性眼内炎,共纳入295例患者295只眼,每个研究为63~96例,男性占51.0%~58.7%,其中1篇文献无性别数据,平均年龄66.9~76.0岁,平均随访12.7~15.7个月。研究干预措施为万古霉素联合阿米卡星或头孢他啶玻璃体腔注射治疗,联合地塞米松玻璃体腔注射和(或)联合手术治疗,综合治疗后视力较前有明显改善;本次研究所纳入5篇研究中,未见任何关于玻璃体腔注射万古霉素的眼内或全身系统性不良反应报告。结论 外源性眼内炎患者,包括眼手术后或眼外伤后,玻璃体腔注射万古霉素或万古霉素+阿米卡星或万古霉素+头孢他啶进行经验性治疗有助于改善患者视力水平。但尚需开展高质量随机对照试验或队列研究验证。
Objective To evaluate the efficacy and safety of vitreous injection of Vancomycin in the treatment of endophthalmitis,and to provide a reference for clinical decision making. Methods PubMed,EMbase,Cochrane Library,ClinicalTrials. gov,CNKI,Wanfang Database,NTIS and SIGLE two grey literature databases were searched by computer. Clinical studies on the efficacy and safety of intravitreal Vancomycin in the treatment of endophthalmitis were collected from the database establishment to April 25,2022. Two evaluators independently screened the literature according to inclusion and exclusion criteria,extracted the data,and evaluated the quality. Qualitative analysis was used to describe the results. Results Finally,1cohort study and 4 case series studies were included. In the cohort study,16 cases of ophthalmitis were treated by Vancomycin injection and 18 cases were treated by Gentamicin injection. The effective rate was similar between the two groups,however the significant effective rate was 50. 0% in the Vancomycin group and 16. 7% in the Gentamicin group,and the difference was statistically significant(P<0. 05). A total of 295 patients(295 eyes)were included in four case-series studies,all of which were exogenous endophthalmitis,with 63-96 patients in each study and 51. 0%-58. 7% male patients. One of the studies had no gender data. The average age was 66. 9-76. 0 years,and the average follow-up was 12. 7-15. 7 months. The intervention was intravitreal injection of Vancomycin with Amikacin or Ceftazidime intravitreal combined with Dexathasone and(or)surgery,and the visual acuity improved significantly after combined treatments. There were no reports of intraocular or systemic adverse reactions to intravitreal Vancomycin injection in the enrolled 5 studies,intravitreal combined with Dexathasone and(or)surgery,and the visual cotacuty impioved significantly after combinecl. Conclusion Empiric treatment with intravitreal Vancomycin or intravitreal Vancomycin + Amikacin or intravitreal Vancomycin + Ceftazidime in patients with exogenous endophthalmitis,including after eye surgery or trauma,may help improve visual acuity. However,high-quality randomized controlled trials or cohort studies are needed to verify this.
作者
计紫超
解玥
王昕
李光耀
张弨
JI Zi-chao;XIE Yue;WANG Xin;LI Guang-yao;ZHANG Chao(Department of Pharmacy,Beijing Tongren Hospital,Capital Medical University,Bejing 100730,China)
出处
《临床药物治疗杂志》
2022年第7期62-67,共6页
Clinical Medication Journal
关键词
眼内炎
万古霉素
玻璃体腔注射
endophthalmitis
Vancomycin
intravitreal injection