青光眼术后滤过泡感染及滤过泡相关性眼内炎的临床观察  

Clinical observation of filtering bleb infections and filtration bleb-related endophthalmitis after glaucoma surgery

作　　者：张蕾[1] 陶静[1] 吴雅颖[1] 

机构地区：[1]嘉兴市第二医院眼科,浙江嘉兴314000

出　　处：《中华医院感染学杂志》2012年第16期3541-3543,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨青光眼术后滤过泡感染及滤过泡眼内炎的危险因素以及临床表现和预后转归。方法查阅近5年医院行青光眼滤过手术的病历,依据术中是否放置丝裂霉素C(MMC)分为两组,讨论MMC的放置增加滤过泡感染的可能性;并总结医院近5年滤过泡感染及相关性眼内炎的病历,将其分为单纯感染组和眼内炎组,探讨其临床表现、病原学、治疗及临床预后。结果手术中巩膜下放置抗代谢药物,术后发生滤过泡相关感染的患者为1.36%,而手术中未使用抗代谢药物组为0.44%,两组比较差异有统计学意义(P<0.05),单纯滤过泡感染组治疗前后眼内压分别为(16.25±3.30)、(14.88±3.42)mm Hg,眼内炎组治疗前后眼内压分别为(18.36±14.12)、(15.00±3.12)mm Hg,两组比较差异无统计学意义;在病原学检查方面眼内炎组革兰阴性菌和革兰阳性菌感染的例数分别为8例和7例,而单纯滤过泡感染组则为7例和3例,两组比较差异无统计学意义。结论术中单次应用抗代谢类药物可以有效提高滤过泡的功能化率,但其与滤过泡相关性感染密切相关,术中慎用。OBJECTIVE To discuss the risk factors for filtering bleb infections and filtration bleb-related endophthalmitis after glaucoma surgery and the clinical manifestation as well as the prognosis outcomes. METHODS The medical cases with filtering bleb infections who underwent glaucoma surgery in recent 5 years were retrospectively investigated, those participants were divided into two groups according to the intraoperative placing MMC, the possibility of placing MMC in increasing the risk of filtering bleb infections was discussed. The filtering bleb infection cases were divided into the simple infection group and the endophthalmitis group, the clinical manifestations, etiology, treatment, and the clinical prognosis were discussed. RESULTS The incidence of postoperative bleb infections in the non-antimetabolites group was 0.44%, the antimetabolites group 1.36 %, the difference was statistically significant（P〈0.05） ; the intraocular pressure of the simple herpes bleb infection group before and after the treatment were （16.25±3.30） mmHg and （14.88±3.42） mmHg,respectively; while （18.36 ±14. 12）mmHg and（15. 00 ±3. 12）mmHg in the endophthalmitis group, the difference was not statistically significant; as for the etiology examination, there were 8 cases with gram-negative bacteria infections and 7 cases with gram-positive bacteria infections in the endophthalmitis group, while 7 cases and 3 cases respectively in simple herpe bleb infections group, the difference was not statistically significant. CONCLUSION A single application of intraoperative antimetabolite drugs can effectively improve the filtering bleb function change rate, but it is closely related to the filtering bleb infections so that it should be used painstakingly.

关 键 词：青光眼 滤过泡感染 滤过泡相关性眼内炎 

分 类 号：R181.32[医药卫生—流行病学]