Endophthalmitis following cataract surgery: the role of prophylactic postoperative chloramphenicol eye drops

Purpose: The main aim of the study was to assess whether omitting prophylactic postoperative topical antibiotics (chloramphenicol) influenced the risk of developing endophthalmitis after cataract surgery. Methods: We conducted a retrospective study including all patients who had cataract surgery at our outpatient cataract unit between 2004 and 2011. Postoperative topical antibiotics (chloramphenicol) were omitted from 2007 onwards, as was the first postoperative day review. Patients with a diagnosis of endophthalmitis after cataract surgery were extracted, and the rate of postoperative endophthalmitis (PE) before and after changing these routines was compared. The diagnosis of PE was defined as severe intraocular inflammation requiring prompt vitreous sampling for culture. Results: Seven thousand one hundred and twenty‐three and 8131 cataract surgeries were performed in the following periods: January 2004 through December 2006 (period 1) and January 2007 through December 2010 (period 2), respectively. Five cases of PE were identified in period 1 (0.070%) and four patients in period 2 (0.049%). The median time between cataract surgery and onset of symptoms was 6 days in period 1 and 4.5 days in period 2. Median time for intervention was 7 and 5 days postsurgery, respectively. Conclusion: We found no difference in the frequency of PE following cataract surgery when changing the postoperative topical medication from a mixture of corticosteroids and antibiotics to only corticosteroids.     

白内障摘出术后急性眼内炎的治疗

目的探讨白内障摘出术后急性眼内炎的病因、临床特点、治疗及预防。方法对15例（15眼）经临床或病理诊断为白内障摘出术后急性眼内炎，进行治疗和疗效分析。结果15例中，13例行玻璃体切除联合注药术，2例行前房冲洗和药物治疗，其中10例术中摘出人工晶状体，所有患眼炎症均被控制；1例眼球萎缩；10例最终视力低于0．1。结论白内障摘出术后急性眼内炎经及时治疗可控制炎症，但视力预后差。预防主要依靠各环节的无菌操作。     

山东省莱芜市白内障手术复明效果及术后并发症的调查

目的 了解白内障手术后的复明情况,并探讨其影响因素及有效的解决方法。方法 采用大样本含量分层整群随机抽样法对山东省莱芜市人群进行普查,记录白内障患者的手术类型、术后视力及术后并发症情况,将结果进行统计学分析。结果 共查出白内障术后患者1089例（1274只眼）。盲和低视力的发生率分别为4.87%和23.70%。术后发生角膜失代偿,继发性青光眼、晶状体后囊膜混浊、黄斑囊祥水肿和视网膜脱离者650只眼（51.02%）,治疗后因这些术后并发症导致的盲及低视力发生率由治疗前的4.87%、23.70%分别降至1.96%和6.01%。白内障针拨术和囊内白内障摘除术的手术脱盲率和最终脱残率最低,术后并发症的发生率最高。结论 适当选择白内障手术类型;对农村地区白内障术后患者进行定期随诊及普查,及时发现,治疗术后并发症,对提高白内障手术的脱盲率和脱殖率具有极为重要的意义。     

Change in ocular alignment after topical anesthetic cataract surgery

Background  To report the incidence of, and change in ocular misalignment following topical anesthetic cataract surgery. Methods  Prospectively, 160 consecutive patients who were scheduled for cataract surgery under topical anesthesia were evaluated. All patients had a complete ophthalmic examination, including ocular alignment evaluation, just before and 1 day, 1 week, 3 weeks, and 2 months after cataract surgery. Results  Preoperatively, 26 patients had ocular misalignment. Mean deviation in these preexisting misalignment was 7.2 ± 6.8 prism diopters (PD). Postoperatively, the angle of deviation improved to 5.4 ± 7.4 PD. Acquired ocular misalignment after cataract surgery occurred in 12 of 160 patients (8%) at 1 day, and seven of 131 (5%) at 2 months. None of these seven patients sought medical attention for the diplopia. Conclusions  The overall incidence of topical anesthesia-related change in ocular alignment after uneventful cataract surgery was 5%. However, no patients had symptomatic diplopia. Topical anesthetic cataract surgery could abolish the risk of postoperative diplopia and improve the heterophoric status of preexisting misalignment. None of the authors has any financial interest in this study.     

Change in Nationwide Incidence of Post-Cataract Surgery Endophthalmitis: Korean Cohort Study from 2002 to 2013

Purpose: To investigate the change in nationwide incidence of endophthalmitis following cataract surgery in Korea from 2002 to 2013.

Methods: From a national sample cohort (n = 1 025 340), cases of postoperative endophthalmitis between 2002 and 2013 were identified.

Results: From 70,719 cases of cataract surgery, 49 incidents of endophthalmitis were reported, yielding an incidence of 0.069% (95% confidence interval [CI], 0.051–0.092%). Overall, the endophthalmitis incidence decreased from 0.103% in 2002–2005 to 0.045% in 2010–2013, corresponding to an annually decreasing time-trend (0.902, 95% CI, 0.827–0.984). In diabetic patients, however, the incidence was 0.128% and did not change (time trend, 1.015; 95% CI, 0.828–1.245).

Conclusions: This study revealed the incidence of endophthalmitis decreased during a 12-year period, but remained constant in diabetic patients.     

Trends in cataract surgery and postoperative endophthalmitis in Western Australia (1980-1998): the Endophthalmitis Population Study of Western Australia

Objectives: Postoperative endophthalmitis results from an intraocular infection and usually occurs following cataract surgery. It has significant morbidity and causes severe visual impairment or blindness of the eye. The aim of this study was to assess the trends in the incidence rates of cataract surgery and postoperative endophthalmitis in Western Australia for the period 1980?1998. Methods: The Western Australian Record Linkage Project was used to link the morbidity records for all patients treated for cataract surgery in Western Australia in 1980?1998. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to cataract surgery and postoperative endophthalmitis. All cases of postoperative endophthalmitis were validated by case‐note review. The separate databases of the Royal Perth Hospital microbiology and anaesthetic departments as well as the vitreo‐retinal surgeon logbooks were used to cross‐validate the hospital morbidity database. Trends in the incidence rates of cataract surgery and postoperative endophthalmitis were assessed by Poisson regression. Results: There were 94 653 cataract procedures performed for 63 007 patients in Western Australia during the 19‐year period. The majority (88%) of cataract procedures performed were in patients aged 60 years or older. Postoperative endophthalmitis developed in 188 patients, with serious visual impairment occurring in 70.6% of patients for whom visual acuity data was available at presentation. The incidence rate of cataract surgery increased more than three‐fold from 1981 (102 per 100 000 person years) to 1998 (345 per 100 000 person years), mainly due to the increase in extracapsular cataract extraction during the 1980s and phacoemulsification extraction from 1990 onwards. In contrast, the average annual incidence rate of postoperative endophthalmitis remained relatively unchanged at around 2 per 1000 cataract procedures over the same period. Conclusion: Cataract surgery is becoming more prevalent in the elderly as the life expectancy of the population increases. There has been a dramatic shift in surgical practice during the last 30 years with small‐incision phacoemulsification being the predominant method of intervention used since 1990. Despite changes in surgical practice the incidence rate of postoperative endophthalmitis has remained the same.     

外伤性白内障术后低眼压的原因及处理

目的 探讨外伤性白内障术后低眼压的原因及处理方法。方法 对外伤性白内障人工晶状体植入术后低眼压27例进行病因分析及治疗结果分析。结果 27例中11例结膜和巩膜切口都有渗漏，3例巩膜隧道切口闭合不良伴结膜下积液，2例人工晶状体袢的固定缝线过长而形成引流，8例为玻璃体切除术后引起的一过性低眼压，2例睫状体脱离，1例脉络膜脱离。根据导致其低眼压的原因进行治疗。所有患者治疗后眼压恢复正常，均在10mmHg以上(1mmHg=0．133kPa)。结论 外伤性白内障人工晶状体植入术后低眼压原因多种，针对导致其低眼压的原因进行治疗，可取得较满意效果。     

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。     

Intravitreal moxifloxacin injections in acute post-cataract surgery endophthalmitis: Efficacy and safety

Purpose:The aim of this study was to evaluate the efficacy and safety of intravitreal moxifloxacin injections in the treatment of acute post-cataract surgery endophthalmitis with visual acuity equal to or greater than hand movements.Methods:Fifty two patients with post-cataract surgery endophthalmitis who presented within 6 weeks with visual acuity equal to or greater than hand movements received two intravitreal moxifloxacin injections 48 h apart. Patients with prior history of ocular disease or treatment were excluded. Patients were followed up to 3 months either for resolution of endophthalmitis or worsening of disease. Number of patients who achieved visual acuity equal to or better than 20/40 and 20/200 at the third-month follow-up visit were compared with the number of patients at presentation, using Chi-square test. In addition, pretreatment LogMAR visual acuity at the time of presentation was compared with posttreatment visual acuity at end of third month using paired t test.Results:Fifty (96.15%) patients showed complete resolution of endophthalmitis while three patients required vitrectomy. Forty-one (78.85%) and 49 (94.23%) patients achieved visual acuity equal to or better than 20/40 and 20/200, respectively, at the third-month follow-up visit as compared to eight (15.38%) and 13 (25%) patients, respectively, at presentation (P < 0.05). In addition, mean LogMAR visual acuity at the time of presentation was 0.755 which improved to 0.307 at the third-month follow-up visit (P < 0.05). None of the patients developed hypersensitivity reactions to intravitreal moxifloxacin.Conclusion:Intravitreal moxifloxacin injections showed promising results in acute post-cataract surgery endophthalmitis.     

Exudative retinal detachment following cataract surgery in Hallermann-Streiff syndrome

Purpose To report two cases of Hallermann-Streiff syndrome with exudative retinal detachment after cataract surgery. Methods Case report. Results Four eyes of two patients with Hallermann-Streiff syndrome developed exudative retinal detachments after lensectomy and anterior vitrectomy at 2 and 4 months of age. Both patients had extreme microphthalmia. The exudative retinal detachment regressed spontaneously in three of the four eyes; however, one eye required subscleral sclerectomy. In one patient, the best-corrected visual acuity was 20/200 at 3 years of age; the other patient had good fixation and following behavior in each eye at 1 year of age. Conclusions Early surgery to treat congenital cataracts in extremely microphthalmic eyes associated with the Hallermann-Streiff syndrome may induce exudative retinal detachment. However, the retinal detachments tend to regress and may not cause severe visual impairment. The authors have no proprietary interest in any aspect of this report.     

Povidone-iodine concentration and dosing in cataract surgery

Iodine has been recognized as an effective bactericide since the 1800s, and povidone-iodine (PI) solution has been applied to the ocular surface and periocular skin since the 1980s to prevent endophthalmitis in cataract surgery. In vitro, PI solution kills bacteria quickly at dilute concentrations (0.05%–1.0%). In many instances, PI kills bacteria more quickly at these dilute concentrations than more conventional (5%–10%) concentrations. This is due to greater availability of diatomic free iodine in dilute solution, the bactericidal component of PI. The toxicity of PI, both in vitro and clinically, has been shown to be related to concentration. Current American Academy of Ophthalmology and the European Society of Cataract and Refractive Surgeons recommendations regarding PI use suggest using 5% PI before surgery. An alternative dosing strategy uses dilute PI repetitively throughout cataract surgery (0.25% every 30 seconds). We review the povidone-iodine literature with attention to basic science and use of dilute PI.     

白内障患者手术后干眼不应忽视

白内障患者手术后发生干眼的问题已经引起了国内外学者的注意.白内障患者术后干眼可分为早期(可逆性)干眼和慢性(不可逆性)干眼,前者术前泪液分泌功能多为正常,由于手术及术后用药等因素的影响,术后泪液分泌暂时性减少,随着相关因素的去除,其功能可以恢复正常;后者术前已患有干眼,或泪液分泌功能处于"边界状态",手术及术后相关因素加剧了泪液分泌的异常,甚至造成眼表组织的异常.及时发现和正确处理术后干眼,对维持眼表稳定性和更好地恢复视力均有重要的临床意义.     

白内障患者手术前后干眼的临床观察

目的探讨白内障患者手术后干眼症的发病情况。方法对37例（50只眼）白内障患者在白内障手术前3d、术后1周、1和3个月进行眼部检查。检查项目包括：裂隙灯显微镜观察眼表情况、角膜和结膜荧光素染色、泪液膜破裂时间（BUT）、Schirmer试验Ⅰ（STⅠ）、结膜印迹细胞学（IC）检查。使用眼表疾病指数调查表评价干眼症对生活质量的影响,应用25项改良美国国家眼科研究所视觉功能问卷了解患者眼部情况、日常生活和视功能的总体情况。结果白内障患者经白内障手术获得了良好的视功能,但术后部分患者出现顽固性干眼症状。白内障术后患者可出现泪河线变窄,BUT变短、STⅠ减少,角结膜荧光素染色加重。此现象可在术后1周即可出现,术后1个月时达到最明显的状态,术后3个月时部分患者的症状可有一定程度恢复。IC检查显示：术后结膜杯状细胞的密度明显低于术前。结论白内障手术后患者可能出现明显的干眼症状和体征,应及时给予干预和治疗。     

白内障术后眼内炎保留人工晶状体的治疗

目的 探讨在保留人工晶状体(IOL)情况下,玻璃体切除联合硅油填充手术治疗白内障术后眼内炎的疗效.方法 回顾性系列病例研究.收集2003至2008年因超声乳化自内障吸除联合IOL植入而发生术后眼内炎,在保留IOL的情况下接受玻璃体切除联合硅油填充术的7例患者(7只眼)的临床资料,观察其视力、裂隙灯显微镜、直接和间接眼底镜、眼压及眼部B超扫描结果 ,对手术疗效进行分析.采用配对t检验分析术前及术后眼压变化.结果 7例患者中男性5例,女性2例,年龄67.0～84.0岁,平均(70.0±4.5)岁.眼内炎发生时间平均为术后2 d(1～3 d).其中5只眼于术后3～6个月将硅油取出.术前视力无光感至手动.术前眼压平均为(35.0.±0.5)mm Hg(35.0～56.0 mm Hg,1 mm/Hg=0.133 kPa).平均随访(10±6)个月(6～43个月).术后视力无光感至0.8,视力提高6只眼(86%),不变1只眼(14%).眼压平均为(18.0±1.5)mm Hg(10.0～20.0mm Hg),显著低于术前眼压(t＝1.94,P＜0.05).并发症主要包括术后早期前房炎性渗出(7只眼),术后短暂高眼压(1只眼).无视网膜脱离和眼球萎缩.结论 在保留IOL情况下,玻璃体切除联合硅油填充手术对治疗超声乳化白内障吸除联合IOL植入术后眼内炎有一定疗效.     

冲洗娩核法在白内障术中的应用

目的 探讨小切口非超声乳化白内障囊外摘出术中晶状体核的娩出方法。方法 术中娩晶状体核时用5ml注射器带弯冲洗针头,自6～8mm宽隧道切口进入前房,轻轻下压切口后唇注入BSS。这时晶状体核缓慢向切口移动而排出切口外。结果 26例应用冲洗娩核法均顺利地娩出晶状体核,作为冲洗组。另选22例进行常规小切口非乳化囊外摘出术作为对照组。冲洗组和对照组脱盲率分别为100％和90.1％;脱残率为65.4％和50％。术中后囊破裂为0和9.1％;术后角膜水肿为11.5％和54.5％;前房渗出为23％和36.4％。人工晶状体表面膜为0和4.5％;高眼压为0和4.5％。两组对比,术后并发症的发生率差异有显著意义(P<0.05)。结论 该方法避免了器械进入前房,减少了并发症,提高了手术效果,而且操作简单易行。     

连续双眼白内障手术人工晶状体选择的进展

双眼白内障在短期内先后进行手术在临床上多见,但连续双眼白内障的手术时机以及是否需要根据第一眼的屈光误差来调整第二眼人工晶状体（IOL）的计算是眼科医师容易忽略的问题.尽管手术技术、IOL材料以及IOL计算公式的改进使手术前IOL度数预计与术后实际值之间的误差越来越小,但仍有5％的屈光误差大于±1D.利用第一眼的屈光误差值计算第二眼的IOL方法,通过第一眼的预测误差进行50％的调整可以明显的提高第二眼手术后的效果.同时,由于IOL植入术后1个月内屈光状态的变化,建议双眼手术时间最好间隔3～4周.这为临床中双眼连续白内障手术时机和IOL的选择提供了有利的指导.     

干眼症患者白内障手术后的观察

目的：探讨干眼症患者白内障手术后应进行的观察及治疗。方法：22例干眼症患者中4例伴口腔干燥及类风湿因子阳性的患者为A组，18例单纯角结膜干燥的患者为B组。所有术眼均进行白内障囊外摘除联合人工晶状体植入。术后给予典必殊目水（Tobredex,0.3%妥布霉素＋0.1%地塞米松）及泪然目水（Tears Naturale Ⅱ,0.3%羟丙基甲基纤维素，Alcon公司）。结果：两组术眼术后都出现了角膜上皮缺损，A组较B组上皮缺损严重且持续时间长，恢复慢。结论：干眼症患者白内障手术后易出现角膜上皮缺损，尤其是伴类风湿因子阳性的患者。因此术后应密切观察角膜情况及伤口恢复情况，并及时给予积极治疗。     

三联术治疗慢性青光眼合并白内障的体会

目的：观察白内障摘除加人工晶体植入加小梁切除术（三联术）治疗慢性青光眼合并白内障的疗效。方法慢性青光眼合并白内障18例20眼,行白内障超声乳化或小切口非超声乳化白内障摘除加人工晶体植入加小梁切除术,术中做三角形巩膜瓣;球结膜瓣及巩膜瓣下用含丝裂霉素C(MMC 0.2mg/ml)棉片浸润5分钟,彻底冲洗;部分病人术毕前房内注入消毒空气泡,观察其视力、滤过泡、眼压及并发症等情况。结果18例20眼通过三联术治疗,视力提高、功能性滤过泡17眼,无明显滤过泡3眼,眼压均正常。其并发症主要是：早期浅前房、角膜水肿、前房反应、前房出血等。结论三联术治疗慢性青光眼合并白内障效果满意。