白内障术后眼内炎的危险因素分析及预后

目的：探讨白内障术后眼内炎的危险因素及玻璃体切割术治疗术后眼内炎的预后。
　　方法：研究在我院进行白内障手术患者1900例1900眼,根据术后有无发生眼内炎分为感染组与对照组。分析患者各临床指标对白内障术后眼内炎发生的影响,采用单因素检验及多因素Logistic回归分析相关危险因素。另外,对所有眼内炎患者进行玻璃体切割术治疗,观察手术对患者预后的影响。
　　结果：单因素分析显示,年龄、高血压、糖尿病、玻璃体溢出、手术时间、普通手术室内进行手术以及麻醉剂开启后未在规定时间内使用等均是导致白内障术后眼内炎发生的危险因素( P<0.05);多因素Logistic回归分析显示,年龄≥70岁、高血压、糖尿病、玻璃体溢出、手术时间≥10 min、普通手术室进行手术以及麻醉剂开启后未在规定时间内使用均是导致白内障术后眼内炎发生的独立危险因素(P<0.05)。经玻璃体切割术治疗后,患者视力得到明显的提高(P<0.05)。
　　结论：年龄、高血压、糖尿病、玻璃体溢出、手术时间、普通手术室进行手术以及麻醉剂开启后未在规定时间内使用等因素均是导致白内障术后眼内炎发生的危险因素。而通过玻璃体切割术治疗,能够有效改善患者的视力。     

白内障术后发生眼内炎危险因素的Meta分析

目的：探讨我国白内障患者术后眼内炎发生的主要危险因素,为今后防治工作提供依据。
　　方法：利用 Meta 分析方法分析国内5篇关于白内障术后眼内炎发病危险因素的研究文献。
　　结果：年龄(≥70岁)、糖尿病史、玻璃体溢出、手术时间(≥10min)、普通手术室及控制麻醉剂时效的合并 OR 值(95% CI)分别为：1.81(1.43~1.69),3.66(1.64~8.16),2.21(1.46~3.32),3.54(2.47~5.06),2.77(2.07~3.72),2.09(1.53~2.86)。
　　结论：年龄(≥70岁)、糖尿病史、玻璃体溢出、手术时间(≥10min)、普通手术室及控制麻醉剂时效是白内障术后眼内炎发病的主要危险因素。     

白内障术后急性眼内炎的发病率

眼内炎是指眼内液或眼内组织的炎症反应.感染性眼内炎是眼科手术的一种最严重的合并症.常致患眼失明,甚至丢失眼球.术后急性感染性眼内炎是指发生在眼科手术后6周内的眼内炎.白内障手术是眼科中最常见的内眼手术,90%的术后眼内炎发生在此种手术后.因此,充分认识其发病的各相关因素,并相应采取各种措施,认真防治,历来都是眼科医师十分重视的突出问题.现就白内障术后急性跟内炎发病率有关问题综述如下.     

白内障术后眼内炎药物预防研究进展

白内障术后眼内炎是一种少见但破坏性极大的并发症。预防眼内炎的方式多种多样,其中术前应用聚维酮碘（povidone iodine,PVI）,术毕前房注射抗生素如万古霉素、头孢呋辛和氟喹诺酮类药物,以及围手术期局部抗生素应用是预防眼内炎的主要方式。本文就白内障术后眼内炎的流行病学、危险因素、致病因素及药物预防的研究进展作一综述。     

白内障术后眼内炎

白内障术后眼内炎作为一种外源性眼内炎,是白内障手术最严重的术后并发症之一,多是由细菌和真菌感染引起.了解并掌握白内障术后眼内炎的风险因素,对于预防和治疗该病具有重要的临床意义.及时的诊断对于视力的愈后具有决定性意义,目前玻璃体内药物注射已成为主要的治疗方案,而全身应用抗生素是否有益尚未达成共识.     

年龄相关性白内障术后发生感染性眼内炎的病原学特点及相关因素

目的：探究年龄相关性白内障手术后发生感染性眼内炎的病原学特点及相关因素与预防。

方法：回顾性分析本院2016-01/2018-01收治的1 365例年龄相关性白内障患者,统计患者感染性眼内炎发生情况,并分析感染性眼内炎病原学特点及相关危险因素。

结果：患者28例发生感染性眼内炎,共检出病原菌36株,其中表皮葡萄球菌9株(25.00%),铜绿假单胞菌9株(25.00%),芽孢杆菌8株(22.22%)。铜绿假单胞菌、芽孢杆菌对头孢唑林、头孢噻肟、阿莫西林具有较强的耐药性; 对头孢哌酮-舒巴坦、美罗培南的敏感性较高; 表皮葡萄球菌对青霉素、红霉素、阿奇霉素有较强的耐药性,对万古霉素、呋喃妥因、米诺环素的敏感性较高。Logistic多因素回归分析,年龄(≥70岁)、糖尿病、手术时间(≥15min)、术中玻璃体溢出是年龄相关性白内障术后发生感染性眼内炎的独立危险因素(P<0.05)。

结论：年龄相关性白内障手术后感染性眼内炎病原菌以表皮葡萄球菌、铜绿假单胞菌、芽孢杆菌多见。年龄(≥70岁)、糖尿病、手术时间(≥15min)、术中玻璃体溢出为年龄相关性白内障手术后发生感染性眼内炎的独立危险因素。     

白内障术后感染性眼内炎的临床分析

目的探讨白内障摘出术后感染性眼内炎的发病因素、治疗方法及效果。方法回顾分析我院10年来,白内障术后眼内炎14例（14眼）的发病因素、治疗方法和后果。结果经过前房冲洗＋玻璃体腔注药和全身抗感染等治疗,所有患眼的感染均被控制,出院时视力1眼无光感;3眼光感;其余10眼均达数指以上。结论白内障术后眼内炎发病因素很多,早期前房冲洗＋玻璃体内注药是控制眼内炎,改善预后的关键,特别是对于无条件开展玻璃体手术的基层医院尤为重要。     

眼内炎玻璃体切除术的效果及预后因素的Cox分析

目的 探讨玻璃体切除术治疗外源性眼内炎的中、远期效果及预后因素.方法 回顾性分析40例（40眼）行玻璃体切除术的外源性眼内炎的临床资料,首先对中、远期疗效进行分析,然后对预后因素进行多元Cox回归分析（Cox比例风险回归模型）.结果 术后患者视力较术前有显著改善（P＜0.05）.术后1周出现不同程度的角膜水肿及前房炎症渗出物;2周后炎症反应缓解、积脓基本消失;3-6月随访期间均未见复发或炎症扩散,7例,于硅油刺激出现后囊浑浊.经多元Cox分析,并发性白内障、视网膜血管炎、晶状体摘出术、术前眼压及术后1周视力,均为影响眼内炎预后的相关因素.结论 玻璃体切除术治疗外源性眼内炎的疗效显著,视力明显提高;影响眼内炎的主要因素包括并发性白内障、视网膜血管炎、晶状体摘出术、术前眼压以及术后1周视力,应对其加以重视,以改善患者预后情况.     

玻璃体切割治疗白内障术后眼内炎疗效观察

目的探讨白内障术后眼内炎的临床特点及治疗方法。方法分析5例（5眼）白内障术后眼内炎的治疗方法。结果5眼白内障术后眼内炎经玻璃体切割术，并辅以全身及局部抗生素治疗，眼内炎症得到控制，视力得到不同程度改善。结论白内障术后眼内炎是白内障手术的严重并发症，玻璃体切割术联合玻璃体腔内注药是一种有效的治疗方法，把握手术时机可以最大限度挽救患者视力，保全眼球。     

白内障术毕应用聚维酮碘对术后眼内炎预防效果的研究

感染性眼内炎目前仍然是白内障摘除及人工晶状体植入术后的严重并发症之一,其发生率为0.06％～0.29％[1-5].感染性眼内炎是极具破坏性的最严重的并发症,一旦发生进展快,预后差,重者常致失明,甚至摘除眼球,因此预防白内障术后细菌性眼内炎的发生有重要意义.大量研究表明来自眼睑和结膜囊的菌群是引起术后眼内炎病原体的主要来源,这些细菌可以通过手术入路进入房水和玻璃体,成为引起眼内炎的危险因素.     

Risk factors of acute endophthalmitis after cataract extraction: a case-control study in Asian eyes

AIM: To describe risk factors of acute endophthalmitis after cataract extraction in an Asian population. METHODS: A retrospective, case-control study. Cases (n = 34) were patients with acute endophthalmitis presenting within 6 weeks after cataract surgery. Three controls per case (n = 102) were randomly selected from the cataract surgery list matched on the date of operation of cases. RESULTS: Few risk factors were identified. In multivariable analysis, endophthalmitis was associated with silicone intraocular lens (odds ratio 5.1, 95% confidence intervals, 1.2 to 21.6, compared to poly(methylmethacrylate) lens) and posterior capsular rupture during surgery (odds ratio 20.9, 95% confidence intervals 2.3 to 187.9). CONCLUSION: Silicone intraocular lens and rupture of the posterior capsule are risk factors of acute endophthalmitis after cataract surgery.     

Significant nonsurgical risk factors for endophthalmitis after cataract surgery: EPSWA fourth report

PURPOSE: Endophthalmitis remains a devastating complication of cataract surgery, despite improved methods of prophylaxis and surgical technique. The current study was conducted to identify sociodemographic, environmental, and clinical risk factors for the development of postoperative endophthalmitis, using population-based administrative data from Western Australia. METHODS: The Western Australian Data Linkage System identified all patients who underwent cataract surgery, along with those in whom postoperative endophthalmitis subsequently developed, from 1980 to 2000 inclusive. Cases of endophthalmitis were cross-referenced with other sources and validated by medical record review. After selection and preliminary analysis of potential risk factors, multivariate logistic regression modeling was used to estimate odds ratios for the selected variables. RESULTS: Over the 21 years, 210 cases of endophthalmitis occurred after 117,083 cataract procedures, yielding a cumulative incidence rate of 1.79 per 1000 procedures. The incidence of endophthalmitis decreased for extracapsular extraction over the whole period, but not for phacoemulsification over the recent 12 years. There was no risk-adjusted difference in the incidence rate of endophthalmitis for the various cataract surgery procedure types. However, a significantly higher risk was found in patients aged over 80 years, in having surgery in private hospitals, and to a lesser degree in having same-day surgery and surgery in winter. Cataract surgery with lacrimal or eyelid procedures dramatically increased the risk of endophthalmitis. CONCLUSIONS: It may be possible to reduce the incidence rate of postoperative endophthalmitis by almost 80% with a systematic approach to the management of elderly patients, hospital stay, and clinical protocols.     

The epidemiology of acute endophthalmitis after cataract surgery in an Asian population

OBJECTIVE: To describe the incidence, risk factors, and clinical outcome of acute endophthalmitis after cataract extraction in a multiethnic Asian population. DESIGN: Prospective case series. PARTICIPANTS: All patients with cataract extractions performed at the Singapore National Eye Center from 1996 to 2001. METHODS: Data on patients with acute endophthalmitis cases presenting within 6 weeks after cataract surgery were prospectively collected in a standardized format. MAIN OUTCOME MEASURES: Acute endophthalmitis after cataract surgery. RESULTS: During the study period, 44 803 cataract operations (25 476 phacoemulsification and 19 327 extracapsular cataract extractions) were performed. There were 34 cases of acute endophthalmitis (average annual incidence of 0.076%), 21 of which were culture positive (average annual incidence of 0.040%). In multivariate analysis, risk of endophthalmitis was associated with phacoemulsification technique (relative risk [RR], 1.9; 95% confidence interval [CI], 0.9, 3.9; P = 0.10 for all endophthalmitis cases; RR, 3.1; 95% CI, 1.1, 9.4; P = 0.04 for culture-positive endophthalmitis cases) and the occurrence of intraoperative posterior capsule rupture (RR, 8.0; 95% CI, 3.1, 20.7; P<0.001 for all endophthalmitis cases; RR, 11.0; 95% CI, 3.7, 23.9; P<0.001 for culture-positive endophthalmitis cases). After a median follow-up of 234 days, half of the eyes achieved a final best-corrected visual acuity of 20/40. Predictors of this visual acuity included baseline acuity of counting fingers or better, culture-negative endophthalmitis, or infection caused by coagulase-negative Staphylococcus. CONCLUSION: The incidence of acute endophthalmitis after cataract extraction in Singapore is consistent with rates reported elsewhere. The phacoemulsification technique is associated with a higher risk of acute culture-positive endophthalmitis compared with extracapsular cataract extraction. Intraoperative posterior capsule rupture is associated with an 8- to 11-fold higher risk of acute endophthalmitis, suggesting that these eyes should be closely monitored for signs of infection in the immediate postoperative period.     

眼内异物伤眼内炎的临床观察

目的:探讨眼内异物伤眼内炎的感染因素、诊治情况.方法:收集256例眼内异物伤中42例发生眼内炎病例,从致病因素、微生物学检测及诊断治疗进行回顾性分析.结果:眼内异物伤眼内炎发生率为16.4%.眼后节异物及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素(P＜0.05).眼内异物伤Ⅰ期给予玻璃体腔注射盐酸去甲万古霉素及头孢他啶可以减少眼内炎的发生率(P<0.05).异物性质及大小、取出时间及伤口情况对眼内炎发生率无明显影响(P＞0.05).眼内异物伤眼内炎手术分级Ⅲ级最多.玻璃体切除手术是治疗眼内炎的主要手术方式.结论:眼后节异物伤及合并外伤性白内障的眼内异物伤是眼内炎发生的危险因素,Ⅰ期手术需处理白内障时尽量保留完整的晶状体后囊膜.建议眼后节异物伤Ⅰ期行玻璃体腔注射万古霉素及头孢他啶.一旦确诊眼内炎,尽早进行玻璃体切除手术.     

Risk factors for endophthalmitis following cataract surgery-our experience at a tertiary eye care centre in India

AIM: To determine the risk factors for acute endophthalmitis after cataract extraction in a tertiary care centre in India. METHODS: We performed a nested case control study within a retrospective cohort. The surgical records of all patients with clinically diagnosed endophthalmitis within one month after cataract surgery, performed between January 2006 and December 2009, were reviewed. These were compared with randomly selected age and gender-matched controls, from patients having routine cataract surgery within ±1wk of the endophthalmitis case. Univariable and multivariable analysis were performed to identify risk factors for endophthalmitis. RESULTS: Of the total 33 856 cataract surgeries performed during this period, there were 57 cases of postoperative acute endophthalmitis that met our study criteria. Thus, the overall incidence of endophthalmitis in our cohort was 1.6 per 1000 cataract extractions performed. Mean age of cases was 55.9y (SD: 10.9y) and for controls was 55.6y (SD: 9.8y). Thirty-five cases (61.4%) and 133 controls (59.6%) were males. Median time of onset of endophthalmitis was 4d (IQR 2-9d; range: 1-30d). Thirty-nine cases (68.4%) presented within 7d and 27 cases (47.4%) were culture positive. Two hundred and twenty-three age and gender matched controls were selected. In multivariate analysis, endophthalmitis was associated with posterior capsular rupture (PCR) during surgery (OR 6.98, 95%CI: 2.22-21.98), phacoemulsification via scleral incision with a foldable intraocular lens (IOL) implantation (OR 3.02, 95%CI: 1.13-8.04) and ocular co-morbidity (OR 2.32, 95%CI: 1.11-4.87). CONCLUSION: PCR, presence of ocular co-morbidity, and phacoemulsification via scleral incision with foldable-IOL were found to be independent risk factors for acute endophthalmitis.     

白内障术后眼内感染及其防治

白内障术后眼内炎是一种严重危害视力的术后并发症，眼内炎的预防包括临床评价各种危险因素、正确的手术步骤和术前术后抗生素预防，只有迅速诊断和有效治疗才能成功地挽救患者的视力。     

Topical anesthesia: possible risk factor for endophthalmitis after cataract extraction

PURPOSE: To assess the relationship between the risk for acute endophthalmitis after cataract extraction and whether certain factors, such as surgeon qualification, numerical order, duration of surgery, operating theater, and type of anesthesia (topical or retrobulbar), could be modified to decrease the risk. SETTING: Single-center academic practice. METHODS: Two epidemiological studies were performed: a case-control study and a retrospective cohort study. The surgical records of all patients with clinically diagnosed endophthalmitis within 30 days after cataract surgery performed between February 2002 and September 2003 were reviewed. The endophthalmitis cases were compared with 108 randomly selected controls (4 controls per case). The global incidence of endophthalmitis and the incidence according to type of anesthesia were calculated. RESULTS: Of 5011 cataract extractions performed, 27 cases of endophthalmitis occurred. The incidence was 5.39 per 1000 procedures. An independent statistically significant relationship was found between endophthalmitis and the use of topical anesthesia (odds ratio [OR], 11.8; 95% confidence interval [CI], 2.4-58.7) and surgery longer than 45 minutes (OR, 7.2; 95% CI, 1.7-29.7) but not between the other variables. The incidence of endophthalmitis was 1.8 per 1000 cataract extractions with retrobulbar anesthesia and 6.76 per 1000 with topical anesthesia (relative risk [RR], 3.76; 95% CI, 0.89-15.85). After the start of the study period was extended to May 2001, the incidence of endophthalmitis was 1.3 per 1000 cataract extractions with retrobulbar anesthesia and 8.7 per 1000 with topical anesthesia (RR, 6.72; 95% CI, 1.63-27.63). CONCLUSION: Results suggest that there may be an association between topical anesthesia and endophthalmitis after cataract extraction.     

Reducing the risk for endophthalmitis after cataract surgery: population-based nested case-control study: endophthalmitis population study of Western Australia sixth report

PURPOSE: To characterize operative and nonoperative risks for the potentially blinding complication of endophthalmitis after cataract surgery. SETTING: Ophthalmology services for the whole state of Western Australia. METHODS: This retrospective population-based nested case-control study in Western Australia covered the period between 1980 and 2000. For each of the 205 cases of endophthalmitis, 4 time-matched controls were randomly selected from all cataract operations performed in the state. Conditional logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of interest. RESULTS: Wound location, suturing the wound, and type of cataract operation did not affect the risk for postoperative endophthalmitis. Antibiotic prophylaxis reduced the risk, but only if given as a subconjunctival injection (OR, 0.46; 95% CI, 0.29-0.70). The risk for endophthalmitis was greater with same-day surgery (OR, 2.27; 95% CI, 1.52-3.41) than with admission the day before surgery. A concurrent eyelid procedure was a substantial risk. Surgeons within 2 years of obtaining specialist qualifications were more likely to have a case of endophthalmitis, although this was partly the result of more posterior capsule breaches. Posterior capsule breach increased the risk when it occurred in private hospitals (OR, 13.57; 95% CI, 4.00-45.99), but not in public hospitals. CONCLUSIONS: Nonoperative as well as operative factors are important in the prevention of endophthalmitis. Subconjunctival injection of antibiotics appears to be beneficial for endophthalmitis prophylaxis. The model showed that active risk management strategies designed to optimize hospitalization and chemoprophylaxis may reduce the incidence of endophthalmitis by up to 81%.