白内障术后眼内炎视力损伤及其治疗效果分析

Analysis of visual impairment and therapeutic effects of intraocular inflammation after cataract surgery

目的总结分析白内障手术后眼内炎临床特征及其住院治疗效果。方法回顾性收集2018年至2023年诊断为白内障手术后并发眼内炎的患者诊疗记录。分析48例白内障手术后性眼内炎患者的发病时间、病原菌及其治疗前后视力改变。结果在收集整理的48例(48只眼)白内障手术后眼内炎临床资料中,绝大多数病例(95.83%)初始视力为盲眼状态,盲目级别为指数(CF)、手动(HM)、光感(LP)和无光感者分别为3例(6.25)、23例(47.92%)、14例(29.17%)、6例(12.5%)。绝大多数(95.83%)为术后急性眼内炎,其中术后4 d内出现眼内炎12例(25.00%),术后2周内出现眼内炎症状26例(54.17%),术后2~6周内出现眼内炎症状7例(14.58%)。细菌总培养阳性率为52.5%,在细菌培养证实的21例白内障术后感染性眼内炎中,绝大多数为革兰阴性菌感染(20/21,95.24%)以及机会性致病菌(19/21,90.48%)。细菌培养阴性组患者治疗后视力障碍分级可以得到改善(P<0.05),而细菌培养阳性组患者治疗后视力障碍分级无明显改善(P>0.05)。住院期间予以前房抗生素灌洗和玻璃体内抗生素注射联合疗法与直接采用玻璃体切除手术和玻璃体内抗生素注射联合疗法二种治疗方案,均可提升视力障碍分级(P<0.05),但未能证实玻璃体切除手术的额外优势。结论白内障手术后4 d至2周是术后眼内炎发病的高危期,以革兰阳性机会性细菌感染为主。与前房抗生素灌洗和玻璃体内抗生素注射联合疗法比较,玻璃体切除手术和玻璃体内抗生素注射联合疗法没有显示额外的疗效优势。

Objective To summarize and analyze the clinical characteristics and hospitalization treatment effects of endophthalmitis after cataract surgery.Methods The medical records of patients diagnosed with postoperative endophthalmitis after cataract surgery from 2018 to 2023 were collected retrospectively.The onset time,pathogenic bacteria and visual acuity changes of 48 cases of endophthalmitis after cataract surgery were analyzed.Results Among the collected clinical data of 48 cases of intraocular inflammation after cataract surgery,the vast majority of cases(95.83%)had initial visual acuity in a blind state,with 3 cases(6.25%),23 cases(47.92%),14 cases(29.17%),and 6 cases(12.5%)classified as index(CF),manual(HM),light perception(LP),and no light perception,respectively.The vast majority(95.83%)were postoperative acute endophthalmitis,with 12 cases(25.00%)experiencing endophthalmitis within 4 days after the surgery,26 cases(54.17%)experiencing endophthalmitis symptoms within 2 weeks after the surgery,and 7 cases(14.58%)experiencing endophthalmitis symptoms within 2~6 weeks after the surgery.The total positive rate of bacterial culture was 52.5%.Among the 21 cases of postoperative infectious endophthalmitis confirmed by bacterial culture,the vast majority were gram negative bacterial infections(20/21,95.24%)and opportunistic pathogens(19/21,90.48%).The visual impairment grading of patients in the negative bacterial culture group was improved after the treatment(P<0.05),while patients in the positive bacterial culture group showed no significant improvement in visual impairment grading after the treatment(P>0.05).During hospitalization,both anterior chamber antibiotic irrigation and intravitreal injection combined with adjuvant therapy,as well as direct vitrectomy and intravitreal injection combined with adjuvant therapy,can improve the grading of visual impairment(P<0.05),but the additional advantages of vitrectomy surgery have not been confirmed.Conclusions The high-risk period for postoperative endophthalmitis is from 4 days to 2 weeks after cataract surgery,mainly due to gram positive opportunistic bacterial infections.Compared with the combination therapy of anterior chamber antibiotic irrigation and intravitreal antibiotic injection,the combination therapy of vitrectomy and intravitreal antibiotic injection did not show any additional therapeutic advantages.