Analysis of post-operative endophthalmitis after pars plana vitrectomy: a 10-year experience at a single center

Background Endophthalmitis can be a devastating complication after pars plana vitrectomy. The incidence of post-vitrectomy endophthalmitis is significantly lower than that of endophthalmitis occurring after other intraocular operations. However, normal post-operative pain and inflammation may mask endophthalmitis and lead to delayed diagnosis and grave visual consequences. This study aimed to summarize the outcomes of cases that underwent pars plana vitrectomy over a 10-year period and to analyze the characteristics of post-vitrectomy endophthalmitis.

Methods A retrospective observational case study was conducted on all the cases who underwent pars plana vitrectomy in the Beijing Tongren Hospital between January 1, 2002 and March 31, 2012. All cases of endophthalmitis that occurred during a period of 10 years and 3 months were reviewed, and the possible risk factors, clinical findings, causative organism(s), and the sources of infection were analyzed.

Results Within the 10-year observational period, 14 patients developed endophthalmitis after pars plana vitrectomy. The incidence of post-vitrectomy endophthalmitis (0.05%) was lower than that reported previously from the same center (0.12%). Staphylococcus epidermidis (five patients, 35.71%) was the most common organism identified in aqueous or vitreous cultures. Eight patients (57.14%) had diabetes mellitus. There was no statistically significant difference (P >0.05) in the incidence of endophthalmitis between period 1 (with antibiotic pretreatment) and period 2 (without antibiotic pretreatment). Surgical procedures for the treatment of endophthalmitis were performed in 10 patients (71.43%).

Conclusions This series of cases showed that the incidence of endophthalmitis after pars plana vitrectomy is lower than what was previously reported in our hospital. A variable degree of corneal edema with relatively normal or mildly increased intraocular pressure was one of the commonly observed characteristics of post-vitrectomy endophthalmitis. Staph. epidermidis was the most common causative organism, and antibiotic pretreatment did not lower the incidence of post-vitrectomy endophthalmitis.

     

玻璃体切除术后非感染性眼内炎

Background Non-infectious endophthalmitis was reported to occur after cataract surgery or intravitreal injections.This study reported a series of patients having non-infectious endophthalmitis after pa...     

玻璃体切除术中医源性视网膜裂孔的临床观察

目的 分析玻璃体切除术中医源性视网膜裂孔的发生情况.方法 回顾性分析行20G标准三通道玻璃体切除手术的患者463例(482眼)的临床资料,分析医源性视网膜裂孔的发生率、部位等,并比较不同临床特征患者术中医源性视网膜裂孔的发生情况.结果 共有44(9.1％)眼术中发生医源性视网膜裂孔,增殖性糖尿病视网膜病变者的发生率最高,为10.9％(28/257).术前无玻璃体后脱离眼的医源性视网膜裂孔发生率为11.8％,高于术前有玻璃体后脱离眼的6.8％(P＜0.05).有晶体眼和无或人工晶体眼的医源性视网膜裂孔发生率分别为9.4％和5.6％,两组比较,差异无统计学意义(P＞0.05).结论 增殖性糖尿病视网膜病变者玻璃体切除术中医源性视网膜裂孔的发生率最高,术前玻璃体未完全后脱离、术中制作玻璃体后脱离者更易出现医源性裂孔,晶状体状态和裂孔的发生无明显关系.     

玻璃体切割术治疗外伤性感染性眼内炎的临床分析

目的 评估玻璃体切割术对外伤性感染性眼内炎的治疗效果。方法 对17例（17眼）眼内炎患者行玻璃体切割手术（大多数患者同时晶体切除）,术中结合庆大霉素玻璃体腔灌注。结果 2例因视网膜坏死术中即行眼内容物剜出术,植入义眼胎。其余15例随访1周至6月,视力在0.04-0.06 8例,0.1-0.2 5例,0.5-1.0 2例。结论 玻璃体切割术能迅速有效地治疗眼内炎,促进病情恢复,避免视网膜脓疡、玻璃体机化、牵引性视网膜脱离,甚至严重的全眼球炎的发生。玻璃体切割治疗外伤性感染性眼内炎是最佳治疗方案,及时诊断,及时治疗是治疗的关键,与患者病情的预后密切相关。     

玻璃体切割与内界膜剥离术联合治疗黄斑裂孔性视网膜脱落的有效性及安全性

目的观察并探讨玻璃体切割(pars plana vitrectomy,PPV)联合内界膜剥离术(internal limiting membrane peeling,ILMP)治疗黄斑裂孔性视网膜脱落(macular hole retinal detachment,MHRD)的有效性及安全性。方法选择MHRD患者64例,随机将患者分为观察组和对照组,每组各32例。对照组32例(32眼)接受PPV术,观察组32例(33眼)接受PPV联合ILMP治疗。术后随访6~12个月,记录患者的愈合、视力恢复及不良反应等情况。结果观察组视网膜复位率为93.9%(31/33),对照组复位率为75.0%(24/32),差异具有统计学意义(P<0.05);观察组视力改善率为81.8%(27/33),对照组为59.4%(19/32),两组相比差异具有统计学意义(P<0.05);两组术前平均最佳矫正视力(BCVA)相比,差异不具有统计学意义(P>0.05),观察组治疗后3个月和6个月的BCVA明显高于对照组,差异具有统计学意义(P<0.05);随访过程中,观察组眼压升高和视野缺损并发症率明显低于对照组,差异具有统计学意义(P<0.05)。结论 PPV联合ILMP术治疗有利于MHRD患者的视网膜解剖复位,对视力恢复具有显著的疗效,且安全可靠,是临床上治疗MHRD的较佳选择之一。     

玻璃体切割术治疗眼内异物

目的：评价玻璃体切割术治疗眼内异物的视力、手术结果及其并发症发生。方法：20眼眼内异物(15眼磁性异物,5眼非磁性异物),做了睫状体扁平部玻璃体切除和眼内异物摘除,3眼视网膜脱离做了充气性视网膜固定术,8眼外伤性白内障同时做了超声乳化白内障摘除和后房型人工晶体植入术。结果：20眼均一次取出异物。术后视力提高16眼(80％);不变3眼(15％);仅1眼(5％)视力减退;最佳矫正视力0．8～0．7。结论：玻璃体切割治疗眼内异物是一安全、有效的手术。在有选择的眼穿通伤合并眼内异物病例中,联合白内障I期后房型人工晶体植入术和玻璃体视网膜手术可以免做两次手术,其主要优点是可以一次手术就较快地恢复视力,减少患者的痛苦和费用。     

Multifocal electroretinogram in evaluating retinal function of diabetic macular edema after pars plana vitrectomy

Beneficial effects of vitrectomy for diabetic macular edema (DME) have been demonstrated in a series of clinical trials. Vitreous surgery is useful in reducing the edema and improving visual acuity.     

Multifocal electroretinogram in evaluating retinal function of diabetic macular edema after pars plana vitrectomy

Beneficial effects of vitrectomy for diabetic macular edema (DME) have been demonstrated in a series of clinical trials. Vitreous surgery is useful in reducing the edema and improving visual acuity,^1,2 Unfortunately,visual acuity measurements only provide information on one aspect of impaired visual function that accompanies DME. According to a report by Greenstein et al,^3visual function can be affected in the fovea, the macnla,     

闭合式玻璃体切除手术后早期患者泪膜功能的变化

目的 观察闭合式玻璃体切除手术对泪膜的影响及术后泪膜功能的恢复情况.方法 42例(42眼)行玻璃体切除手术的患者,分别于术前1 d,术后1、3、7、14 d、1个月及3个月询问患者是否存在不适症状,并行泪膜破裂时间(Break-Up Time,BUT)、泪液分泌试验(Schirmer I test,SIt)、角膜荧光素染色(Cornea Fluorescein Staining,CFS)检查.结果 与手术前相比,术后第1天患者的不适症状评分和CFS评分较术前显著增加(P＜0.01),无法形成稳定的泪膜,而SIt显著增加,83.3%的患者(35例) SIt＞30.0 mm,其余7例患者SIt均＞25.0 mm.术后第3、7天的不适症状评分较术前增加且差异显著(P＜0.01,P＜0.05),至术后14 d恢复至术前水平(P＞0.05).术后第3、7、14天,BUT较术前减少且差异显著(P＜0.01),SIt和CFS较术前增加且差异显著(P＜0.01).至术后1个月,BUT较术前仍减少且差异显著(P＜0.05),SIt和CFS与术前相比差异不显著(P＞0.05),恢复至术前水平.至术后3个月,BUT也恢复至术前水平(P＞0.05).结论 玻璃体切除术可显著影响泪膜的稳定性,至术后3个月,所有检查项目完全恢复至术前水平.     

白内障术后眼内炎的危险因素及临床分析

目的 探讨白内障术后眼内炎的危险因素和临床表现及玻璃体切割术治疗术后眼内炎的预后.方法 收集白内障术后6周内发生眼内炎并于我院行玻璃体切割术的患者25例.将全部患者依据白内障术前既往史中危险因素的有无,分为伴有危险因素组(A组)和不伴有危险因素组(B组),回顾性分析两组的临床表现及预后.结果 两组的病原茵检出率分别为A组60％,B组66％.最终视力1.0以上的比例两组分别为10％和46％,A组显著低于B组(P＜0.05).A组的病原菌以耐甲氧西林金黄色葡萄球菌、溶血性链球菌和肠球菌居多.两组均有约70％的角膜切口出现术后切口闭合不全,且未被结膜覆盖的切口在A组中显著增多(P＜0.05).结论 伴有危险因素的白内障术后眼内炎患者的视力预后不良,对此类患者行白内障手术时必须谨慎选择并制作切口.     

62例儿童眼内炎临床特点及其疗效分析

目的分析儿童眼内炎的临床特点和治疗效果,为临床诊治提供指导。方法回顾性分析2001年1月至2002年12月我院住院患者中儿童眼内炎62例62眼的年龄、性别、致伤原因、就诊时间、感染类型、治疗方式和治疗效果等。结果除4眼放弃治疗外,所有病例炎症都得到控制。视力记录完整的46眼中,Ⅰ组（玻璃体腔注药＋玻璃体手术25眼）视力改善15眼,稳定9眼,减退1眼,Ⅱ组（单纯玻璃体手术12眼）视力改善9眼,稳定3眼,Ⅲ组（单纯玻璃体腔注药9眼）视力改善2眼,稳定7眼。经Mann-Whitney t检验,Ⅰ组与Ⅲ组,Ⅱ组与Ⅲ组手术后视力差异有统计学意义（P〈0．05）,Ⅰ组与Ⅱ组手术后视力差异无统计学意义（P〉0．05）。结论儿童眼内炎由于其自身特点,单纯玻璃体腔注药效果欠佳,一经诊断明确,应立即行玻璃体手术,多数患儿的炎症得到控制,视力得到改善。     

Diagnostic efficiency and complication rate of CT-guided lung biopsy: a single center experience of the procedures conducted over a 10-year period

Background  Computed tomography (CT)-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population.

Methods  CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure (pneumothorax and bleeding) were extracted.

Results  The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions (63.0%) and 322 benign lesions (31.8%). Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%.

Conclusions  CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.

 

     

玻璃体切除术后无晶状体眼的二期人工晶状体植入术

目的 探讨玻璃体切除术后无晶状体眼的二期人工晶状体(IOL)植入术的安全性和疗效.方法 回顾性分析我院2002年7月～2006年1月期间玻璃体切除联合晶状体摘除术患者资料,术后密切随访,对视网膜复位、眼底情况良好、矫正视力明显提高的患眼,前或后囊膜完整,行二期IOL植入手术,共13例13眼.监测术后视力,分析术中、术后并发症的发生及处理情况.结果 联合手术术前最佳矫正视力(Pre-BCVA)0.2～HM/30cm,人工晶状体植入术后最佳矫正视力(Post-BCVA) 1.0～0.04,Post-BCVA较Pre-BCVA明显提高53.85%(7/13);手术后并发角膜内皮水肿2例,前房渗出1例,一过性高眼压1例,经相应对症治疗,上述并发症均痊愈.结论 二期IOL植入手术是玻璃体切割术后的无晶状体眼治疗的较好选择,术后视力的可预测性好,疗效确切.严格掌握适应证,具备相当成熟的手术技巧是手术成功的关键.     

临时人工角膜下穿透性角膜移植联合玻璃体切除手术治疗眼球前、后节外伤的远期疗效

目的 评价临时人工角膜下穿透性角膜移植联合玻璃体切除手术治疗眼球前、后节外伤的远期疗效.方法 对11例(11只眼)眼球前、后节外伤的男性患者,年龄7～46岁,其中,成人患者6例(6只眼),儿童患者5例(5只眼), 施行临时人工角膜下穿透性角膜移植联合玻璃体切除手术.术后观察视网膜,角膜移植片,眼压,视力等.结果 随访4～68个月,平均24.6个月.随访期间,5例成人患者(5只眼,占45.5%) 的眼球得以保留.视力:1例为手动,2例分别为0.05,1例为0.08,1例为0.2 ;眼压:1例患者眼压25 mmHg, 用0.5%噻吗心胺眼液治疗,眼压控制在21 mmHg以下,其余4例患者眼压正常.6例患者(6只眼,占54.5%)眼球萎缩,其中, 5例年龄≤12岁的患儿伤眼都出现萎缩, 另1例成人患者因继发性青光眼,经巩膜的睫状体激光光凝治疗后眼球发生萎缩.结论 临时人工角膜下穿透性角膜移植联合玻璃体切除手术是治疗眼球前、后节外伤的安全和有效方法,眼部的损伤程度可能是影响伤眼预后的主要因素,儿童眼前、后节外伤后联合手术的预后不良.     

肝内胆管囊腺瘤:单中心连续10例诊疗经验

目的总结肝内胆管囊腺瘤(IBCA)的诊疗经验,提高临床诊治水平。方法回顾性总结分析我中心治疗的连续10例经病理学确诊的IBCA,分析其流行病学、影像学、实验室检查、病理学和预后特点。结果 10例患者均为女性,平均年龄48.9(16~73)岁。无症状、轻微症状和明显症状的患者分别为4、4、2例。影像学检查均为多房性囊性肿块,平均直径为(13.3±4.9)cm。内部分隔、乳头或结节样增生、钙化的显示率分别为90%,60%,20%。病理检查大体均为多房性肿块,镜下检查囊内壁均被覆立方或柱状上皮,基质类型为卵巢样(50%)或纤维样(50%)。10例患者中完整切除8例,部分切除2例。平均随访55.3(12~164)月,所有患者均生存。完整切除者均无复发;部分切除者均已复发,且其中1例已恶变。结论IBCA是一种少见的肝内囊性交界性肿瘤,好发于中年女性,影像学检查是术前诊断主要依据。应完整切除肿瘤,以期获得良好生存。     

视网膜脱离玻璃体切割术后早期高眼压发生率及相关因素

目的:探讨视网膜脱离玻璃体切割术(PPV)后早期高眼压发生率和相关的危险因素。方法:回顾性分析2016年5月至2018年4月在我院眼科中心因视网膜脱离行PPV患者227人228只眼。纳入黄斑前膜患者36人36只眼作为对照组。比较视网膜脱离患者性别、术中处理、眼内填充物和是否伴有高度近视等因素,了解高眼压的发生率,分析术后早期发生高眼压的危险因素。结果:视网膜脱离行PPV患者中有65只眼出现高眼压,发生率为28. 5%。术中行单纯光凝、冷凝和光凝+冷凝联合治疗以及对照组患者高眼压发生率分别为27. 9%、10. 5%、34. 4%和2. 8%(P<0. 01)。视网膜脱离术中行硅油填充和空气填充患者高眼压的发生率分别为32. 2%和13. 3%(P<0. 05)。伴有高度近视和不伴有高度近视的视网膜脱离患者高眼压发生率分别为48. 6%和19. 8%(P<0. 01)。视网膜脱离术中行光凝+冷凝联合治疗、硅油填充和伴有高度近视的患者发生高眼压的风险显著增加。结论:视网膜脱离PPV术后早期高眼压的发生与眼内填充物以及有无高度近视有着密切关系。伴有高度近视可以增加视网膜脱离患者PPV术后发生高眼压的风险。术后应长期随访,以避免术后短期眼压升高和长期慢性高眼压带来的视功能损害。     

食管癌术后胃排空障碍的单中心分析

目的 对食管癌术后发生胃排空障碍的病例进行单中心分析,总结其发生原因和诊治经验.方法 回顾性分析第二军医大学长征医院2003年1月至2012年12月间1 294例食管癌患者的病例资料,将其中发生胃排空障碍的19例(1.47％)患者作为观察组,未发生胃排空障碍的l 275例作为对照组.比较两组患者年龄、糖尿病史、吻合部位、手术入路及游离胃方式等,分析可能影响胃排空障碍发生的因素.通过本中心的研究得出胃排空障碍发生规律和治疗手段.结果 术后发生胃排空障碍的19例患者经保守治疗均痊愈.经单因素分析显示,胃排空障碍的发生与患者的年龄、糖尿病史、吻合部位、手术入路和游离胃方式均无关(P＞0.05).结论 食管癌术后胃排空障碍发生率低,发生原因不明确,一旦发生则严重影响患者的生活质量,但经保守治疗均可恢复.     

Acute pancreatitis in pregnancy: a 6-year single center clinical experience

Background  The acute abdomen remains a challenge for all obstetricians and physicians who take part in the care of women in pregnancy. To add substantially to our understanding of acute pancreatitis (AP) in pregnancy, in particular affirming the increased risks for mother and fetus associated with AP, we explored features of clinical manifestation and the strategy of management of this disease during pregnancy, and its effects on maternal and fetal outcomes.

Methods  A retrospective review of medical records of all pregnant patients diagnosed with AP admitted to the Department of Obstetrics and Gynecology, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University between 2005 and 2010 was performed. Information was collected from presentation, management, and outcome from medical records.

Results  There were 11 cases in 2010, accounting for 44% of 25 cases. Among these cases, mild AP (MAP) occurred in 15 cases (60%), while the rest cases were severe AP (SAP) (40%). The major etiology of AP in pregnancy was due to gallstone and cholecystitis. Clinical features together with elevation of the plasma concentrations of pancreatic enzymes were the cornerstones of diagnosis. Positive conservative treatment was taken in most of the cases (21 cases, 84%) with a favorable outcome. Seven cases of critically ill patients were monitored in intensive care unit, and 4 patients underwent surgical interventions. As a result, all of 25 patients had better prognosis, no maternal death was observed. There were 8 preterm labors and 2 fetal losses, accounting for the perinatal mortality of 8%. Fetal malformation was not observed.

Conclusions  While a pregnant woman suffers acute abdominal pain, early diagnosis and severity assessment of AP are very important. Conservative comprehensive treatment with intensive care is recommended. Surgical intervention should be performed as late as possible.

     

Simultaneous pancreas-kidney transplantation in a single center: 10-year retrospective analysis

Background  Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment option for diabetic patients with advanced chronic renal failure. The current study aimed to analyze the surgical indications, treatments and prognosis of SPKT.

Methods  We retrospectively analyzed 40 cases of SPKT performed between December 1999 and January 2010 in our center, including the survival rate, complications and the reasons of reoperation.

Results  Of all the 40 SPKT cases, the one-year survival rates of the recipients, kidney and pancreas transplant graft were 97.6%, 97.6% and 92.7%, while 97.6%, 91.1%, 92.7% at 3 years and 83.6%, 78.0%, 79.4% at 5 years, respectively. After SPKT, 10 patients need reoperation because of surgical complications (14 operations). The reoperation rate was 25%, including 2 patients (4 operations) with hematuria, 4 patients with abdominal hemorrhage, 2 patients (3 operations) with abdominal infection, 1 patient with pancreatic venous thrombosis, 1 patient with anastomotic leakage, and 1 patient with fistula.

Conclusion  Although SPKT provides a successful and effective treatment for diabetics with end-stage renal disease, how to reduce the complications of this treatment still need further effort.

     

白内障摘除及人工晶体植入术后感染性眼内炎的临床分析

目的探讨白内障摘除及人工晶体植入术后感染性眼内炎的易感因素、治疗方法及预防措施。方法回顾分析1999年1月～2010年10月5例感染性眼内炎的临床资料。结果 5例患者均有严重全身疾病,体质弱。2例有明确的切口错位病史,1例为消毒不合格所致。霉菌感染1例。表皮葡萄球菌感染2例。未检出病原体2例。行玻璃体腔内注射治疗1例,角膜移植1例,行玻璃体切割手术3例。所有患者均保住眼球。视力最佳达0.3。结论感染性眼内炎与患者全身状况、手术切口、术后护理、手术环节等有关。及时行玻璃体切割手术是最有效的治疗方法。