白内障术后眼内炎诊治

目的:探讨白内障术后眼内炎的临床表现及诊治方法。方法:回顾性分析2005-05/2008-03我院诊治的4例白内障术后眼内炎病例,总结临床表现及治疗方法。结果:药物治疗2例,玻璃体切除手术治疗2例,全部患者感染控制,视力提高3例。结论:白内障围手术期应制定规范预防方案,严格执行,减少眼内炎发生可能。尽早发现、根据病情选择合理方式是治疗眼内炎的关键。     

Endophthalmitis following cataract extraction

We describe a case of bacterial endophthalmitis complicating routine cataract extraction and intraocular lens implantation in a 91-year-old woman. The ocular and systemic factors that may have predisposed to intraocular infection in this case, and the possibility of predicting these pre-operatively, are discussed.     

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.     

Endophthalmitis after microincision cataract surgery

We report the first case of streptococcal endophthalmitis after uneventful right bimanual phacoemulsification. Microincision cataract surgery is perceived to be minimally invasive as smaller wounds are equated to shortened healing time, increased safety, and reduced risk for postoperative endophthalmitis. Recommendations for modifications in wound construction are discussed.     

Endophthalmitis following cataract surgery in Southwest Finland from 1987 to 2000

Purpose To investigate the incidence, causes, prevention, treatment and outcome of postoperative endophthalmitis (POE) following cataract surgery in south-west Finland from 1987 to 2000. Methods We reviewed the medical records of all patients with POE following cataract surgery treated in the hospital district of Southwest Finland from 1 January 1987 to 31 December 2000. Population-based annual incidence rates of cataract extractions and POE were calculated using the corrected population statistics of the hospital district. Results There were 29,350 cataract procedures during the 14-year period. POE developed in 47 patients. The annual incidence of cataract operations increased more than fivefold from 1987 (155 per 100,000 population) to the maximum in 1999 (930 per 100,000 population), whereas the annual incidence of postcataract endophthalmitis decreased from the maximum of 11.1 per 1,000 cataract extractions (1.91 per 100,000 population) in 1988 to the minimum of 0–0.6 per 1,000 cataract extractions in 1999 and 2000. POE occurred statistically significantly more frequently after extracapsular cataract extraction (ECCE) than after phacoemulsification (Phaco) (P=0.0006). Gram-positive bacteria were the most frequent cause of acute POE and Propionibacterium acnes was the most frequent reason for delayed-onset POE. The complications of POE after cataract surgery included visual loss to below 0.05 (25.5% of affected eyes), opacification of the cornea (21.3%), secondary cataract (40.4%), increase in intraocular pressure (29.8%), vitreous clouding (63.8%), and retinal detachment (6.4%). Nearly one half of the eyes achieved final visual acuity of 0.5 or better. Conclusions During the 14-year study period there was a shift from ECCE to Phaco, a fivefold increase in cataract extractions, and a decrease in the annual incidence of POE from 5.5–11.1 to 0–0.6 per 1,000 operations. Phaco was associated with a lower risk of POE than ECCE. None of the authors has a financial or proprietary interest in any material or method mentioned.     

Endophthalmitis following extracapsular cataract surgery: a review of 32 cases.

Thirty two cases of endophthalmitis following extracapsular cataract surgery that had occurred within our department and had undergone intraocular diagnostic tap between May 1982 and May 1991 were reviewed. An infectious agent was identified in 20 cases (62.5%). The commonest organism was Staphylococcus epidermidis (11 cases) (55%). Proteus was the only gram negative organism identified (four cases) (20%). Both of these organisms were associated with a favourable visual outcome. In the culture positive subgroup 15 eyes (75%) achieved a final acuity of 6/60 or better with 10 eyes (50%) gaining 6/12 or better. Thirteen (65%) of the culture positive cases were managed without vitreal intervention. Of these 11 (85%) achieved 6/60 or better with eight (62%) gaining 6/12 or better. It appears that when an endophthalmitis follows uncomplicated extracapsular cataract surgery delivery of antibiotic by the 'conventional' routes (topical, subconjunctival and systemic) is consistent with a favourable visual result in many cases. A modified anterior chamber diagnostic tap technique is described.     

Endophthalmitis following cataract surgery in Sweden. The 1998 national prospective survey

PURPOSE: To investigate the morbidity of postoperative endophthalmitis (POE) following cataract surgery in Sweden in 1998. METHODS: Clinically presumed cases of POE were reported in a prospective survey in which all Swedish ophthalmic surgical units except one had agreed to participate. Data on intraocular cultures and visual outcomes at 3 months after infection were supplied. Surgical cases that became infected were identified in the Swedish National Cataract Register, thereby enabling screening for various putative risk factors. RESULTS: The nationwide incidence of POE amounted to 58 cases out of 54 666 cataract operations, or 0.1% of surgical cases. The predominant aetiology was gram-positive bacteria, which comprised 57% of the material. Acrylic intraocular lenses were found to decrease the risk of POE significantly in comparison to hydrogel and polymethylmethacrylate lenses. CONCLUSIONS: The incidence of POE after cataract surgery in Sweden is similar to that currently reported elsewhere in the developed world. We hope that continued registration of cases of POE in Sweden will shed light on the possible influences of various prophylactic measures and different intraocular lens materials on the development of postoperative infection.     

Endophthalmitis following cataract surgery in Sweden: national prospective survey 1999-2001

PURPOSE: To investigate the epidemiology of postoperative endophthalmitis (POE) following cataract surgery in Sweden during a 3-year period, using the framework of the Swedish National Cataract Register. METHODS: Clinically presumed cases of POE were reported in a prospective survey involving all Swedish ophthalmic surgical units except one. Data on results of the intraocular culture and visual outcome after infection, as well as patient age and gender and various elements of the surgical procedure, were collected. RESULTS: The nationwide incidence of POE was 0.0595%, representing 112 cases in 188 151 cataract operations. Gram-positive bacteria were the predominant aetiology, with an 84.6% share of culture-positive cases. A significantly decreased risk for POE was found for patients who had received prophylactic intracameral antibiotics (mainly cefuroxime) in comparison with those who had been treated with topical antibiotics only. CONCLUSIONS: The prevalence of POE after cataract surgery in Sweden is at the lower end of the spectrum of incidence currently reported in the developed world. The administration of intracameral antibiotics may have contributed to these results.     

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.     

Endophthalmitis outbreaks following cataract surgery: causative organisms, etiologies, and visual acuity outcomes

A systematic review of 27 reports of endophthalmitis outbreaks following cataract surgery between 1985 and 2011 found the 2 most common causes associated with the outbreaks were contaminated solutions, 10 reports (37%), and contaminated phacoemulsification machines, 6 reports (22.2%). Other possible sources of contamination included ventilation systems, 3 (11.1%); defective sterilization, 3 (11.1%); miscellaneous, 3 (11.1%); in 5 outbreaks (18.5%), no possible source could be identified. Bacteria occurred in 23 outbreaks (85.2%) and fungus in 4 (14.8%). Causative organisms were gram-negative bacteria, 15 (65.2%); gram-positive bacteria, 5 (21.7%); and both gram-positive and gram-negative bacteria, 3 (13.1%). Pseudomonas aeruginosa was causative in 14 of 27 (51.8%) gram-negative bacteria. After treatment in 229 patients, a visual acuity outcome of 20/400 or better was achieved in 127 patients (55.5%). Outbreaks of endophthalmitis following cataract surgery are often caused by gram-negative organisms and can be associated with poor visual outcomes. In this review, the most common source was irrigation solutions used perioperatively. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.     

Endophthalmitis after cataract surgery in China, 1995-2009

A systematic search of the China National Knowledge Infrastructure database for articles on endophthalmitis after cataract surgery between 1995 and 2009 identified 57 articles that included 403 eyes. The incidence of endophthalmitis after cataract surgery was 0.06% (140/233,115). Treatments included intraocular antibiotic injection in 54.1% of eyes and immediate vitrectomy in 40.2%. Of 356 intraocular samples, 214 (60.1%) were culture positive; 187 (87.3%) bacterial and 27 (12.7%) fungal. The presenting visual acuity was <5/200 in 195 (75.3%) of 259 eyes and the final visual acuity, ≥20/40 in 63 eyes (16.8%). During these 15 years, the use of vitrectomy increased significantly (P<.05). The proportion of eyes with a final visual acuity of ≥20/400 also increased significantly (P<.05) during each 5-year period. Although these represent favorable changes in the treatment and prognosis of endophthalmitis, there are differences between these outcomes and those in developed countries. A more unified therapeutic standard is needed to further improve the prognosis of postoperative endophthalmitis in China.