超声乳化白内障吸除术后发生感染性眼内炎的危险因素及防治措施研究  

Risk factors and control measures of infectious entophthalmia after phacoemulsification

作　　者：曹燕[1] 赵俊宏[1] 赵平[1] 梁厚成[1] 

机构地区：[1]西安市第一医院眼科,710002

出　　处：《中华眼科医学杂志（电子版）》2014年第3期132-135,共4页Chinese Journal of Ophthalmologic Medicine(Electronic Edition)

摘　　要：目的探讨超声乳化白内障吸除术后发生感染性眼内炎的因素及防治措施。方法对2009年5月至2013年5月西安市第一医院眼科收治的行超声乳化白内障吸除术的15 000例(25 435只眼)患者的临床资料进行回顾性分析。对于术后出现眼内炎的患者及时行前房穿刺或玻璃体穿刺,抽取标本做涂片检查及细菌、真菌培养,并进行药敏试验。采用全身与局部用药相结合的方法,给予广谱、足量抗生素及少量糖皮质激素治疗,并根据药敏实验的结果选择敏感药物。随访3~6个月,分析治疗后患者眼内炎的预后情况及视力变化情况。结果本组15 000例(25 435只眼)患者行超声乳化白内障吸除术,出现术后感染性眼内炎的患者10例(10只眼),发生率为0.04%。对患者进行房水和(或)玻璃体药敏试验和致病菌培养,最终5例(5只眼)患者的培养结果呈阳性,致病菌检出率达到71.4%;其中真菌(白色念珠菌和酵母菌)感染者1例(1只眼),占20%。芽孢杆菌感染者1例(1只眼),占20%,铜绿假单胞菌感染者1例(1只眼),占20%,表皮葡萄球菌感染者2例(2只眼),占40%。治疗前视力光感或手动者7例(7只眼),占70%,视力0.02~0.1者2例(2只眼),占20%,视力0.2~0.4者1例(1只眼),占10%;经7 d的治疗后,视力光感或手动者4例(4只眼),占40%,视力0.02~0.1者3例(3只眼),占30%,视力0.2~0.4者1例(1只眼),占10%,视力≥0.5者2例(2只眼),占20%。对患者进行3~6个月的随访,最终视力光感或手动者3例(3只眼),占30%,视力0.02~0.1者3例(3只眼),占30%,视力0.2~0.4者2例(2只眼),占20%,视力≥0.5者2例(2只眼),占20%。结论超声乳化白内障吸除术后患者发生感染性眼内炎的主要危险因素为晶状体后囊膜破裂,致病菌主要为表皮葡萄球菌。为了减少术后感染性眼内炎的出现,需要做好术前、术中及术后的全方位工作。Objective To explore the risk factors and control measures of infectious entophthalmia after phacoemulsification.Methods This was a retrospective study, involving a total of 15,000 patients (25,435 eyes) with cataract who underwent phacoemulsification in Department of Ophthalmology, Xi′an No.1 Hospital between May,2009 and May,2013.In those patients who developed infectious entophthalmia after surgery,vitreous humor specimens were collected via anterior chamber or vitreous body puncture for drug sensitivity test and wide-spectrum antibiotics were given together with glucocorticoid at doses determined based on the drug sensitivity test results.The recorded prognostic data during the follow -up (3-6 months) were analyzed.Results Infectious endophthalmitis occurred in 10 cases (10 eyes) after operation with an incidence rate of 0.04%.Vitreous humor specimens, after culture,were pathogen-positive in 5 (71.4%) cases (5 eyes);fungus ( candida albicans and saccharomycetes), bacillus pseudomonas aeruginosa each occurred in 1 case and staphylococcus epidermidis in 2 cases.Before treatment,the visual acuity in the 10 infected eyes was,respectively,under the category of light perception or hand motion in 7 eyes (70.0%), 0.02-0.1 in 2 eyes (20.0%),and 0.2-0.4 in 1 eye (10.0%).After 7 days of treatment,the vision was light perception or hand motion in 4 eyes (40.0%),0.02-0.1 in 3 eyes (30.0%), 0.2-0.4 in 1 eye (10.0%) and better than 0.5 in 2 eyes (20.0%).After 3 -6 months,the vision was light perception or hand motion in 3 eyes (30.0%),0.02-0.1 in 3 eyes (30.0%),0.2-0.4in 2 eyes (20.0%) and better than 0.5 in 2 eyes (20.0%).Conclusions Posterior capsular rupture is the main risk factor of infectious endophthalmitis after phacoemulsification and staphylococcus epidermidis is the major underying pathogen. Implementation of strict infection control measures before, during and the phacoemulsification procedure is highly necessary to reduce the incidence of endophthalmitis in clinical settings.

关 键 词：超声乳化白内障吸除术 感染性眼内炎症 因素 防治措施 

分 类 号：R779.66[医药卫生—眼科]