前房注射头孢呋辛预防白内障术后眼内炎的临床效果

目的　探讨白内障术末前房注射头孢呋辛对眼内炎发生率的影响，评价该预防措施的临床效果。方法　回顾性研究２００９－２０１５年在我科接受白内障手术的１０５１５眼患者资料，统计各年份白内障患者中接受前房注射头孢呋辛的比例、眼内炎的发生率及逐年累积发生率。对术后眼内炎患者的年龄、性别、视力、病原菌及接受注射的情况进行分析。结果　过去７ａ接受白内障手术者５９９５例（１０５１５眼），其中９３８２眼（８９．２％）接受了前房注射头孢呋辛１ｍｇ／０．１ｍＬ。随着头孢呋辛前房注射比例的增加，感染性眼内炎发生率由０．１８２％（２００９年）降至０．０７２％（２０１１年），７ａ总体累积发生率为０．０３８％（９５％ ＣＩ，０．００１－０．０７５）。２００９－２０１１年白内障术后发生眼内炎４例，平均潜伏期３．７５ｄ。２０１２－２０１５年无眼内炎病例发生。所有接受注射的患者未发生药物毒性及过敏反应。结论　白内障术末前房注射１ｍｇ／０．１ｍＬ头孢呋辛安全有效，术后眼内炎的发生率明显降低，有望作为白内障围手术期预防感染的常规措施。

Evaluation of intracameral cefuroxime injection for endophthalmitis prophylaxis following cataract surgery

Objective To evaluate postoperative endophthalmitis incidence after adoption of intracameral cefuroxime injection following cataract surgery in ophthalmology department. Methods This was a retrospective clinical study. The electronic medical records were reviewed for 10 515 eyes with cataract surgeries in our department from 2009 t0 2015. The intracameral injection percentage and incidence of endophthalmitis for each year were calculated. Data of each patient with postoperative endophthalmitis were collected. Results A total number of 10 515 eyes of 5995 patients with cataract surgeries were evaluated over the past 7 years. Among them, 9382 eyes ( 89. 2% ) received intracameral cefuroxime injection( I m~0. I mL) . With the increase of injection cases, the incidence of endophthalmitis deceased from 0. 182% in 2009 to 0. 072% in 2011. The cumulative incidence of postoperative endopthalmitis was 0. 038% (95% CI.O. 001 - 0. 075 ) . Four cases of endophthalmitis after cataract surgery were identified and the mean onset time was 3. 75 days from 2009 t0 2011. No postoperative endophthalmitis case occurred from 2012 t0 2015. No severe complication was reported with application of prophylaxis measure. Conclusion With the safe and increasing use of intracameral cefuroxime ( I mg/0. I mL) , the incidence of postoperative endophthalmitis in our department is obviously low. It can be considered as an effective strategy for the control of postoperative endophthalmitis.