前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析  

Effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis after cataract surgery

作　　者：陶栗 刘玮[1] 叶剑[1] TAO Li;LIU Wei;YE Jian(Department of Ophthalmology,Daping Hospital,Army Medical University(Third Military Medical University),Chongqing,400042,China)

机构地区：[1]陆军军医大学(第三军医大学)大坪医院眼科,重庆400042

出　　处：《第三军医大学学报》2020年第20期2057-2062,共6页Journal of Third Military Medical University

摘　　要：目的探讨低浓度万古霉素预防白内障术后感染性眼内炎的临床效果。方法收集2016-2019年于我院行白内障手术的28845例患者病历资料,根据术毕前房使用药物分为低浓度万古霉素组(0.01 mg/mL,0.1 mL)及头孢呋辛组(10 mg/mL,0.1 mL)。回顾性分析术后患者视力、眼压、角膜,裂隙灯下角膜、前房、人工晶体情况,B超下玻璃体混浊情况,实验室微生物培养情况,已确诊感染性眼内炎患者,分析眼内炎患者的治疗方案及预后。结果共发现感染性眼内炎患者5例5眼,低浓度万古霉素组3例3眼,术后感染性眼内炎发生率为0.0229%,细菌培养结果为1例铜绿假单胞菌、2例表皮葡萄球菌;头孢呋辛组2例2眼,术后感染性眼内炎发生率为0.0127%,细菌培养结果为真菌、缓症链球菌各1例。χ^2分析两组差异无统计学意义,进行非劣效检验,两组术后感染性眼内炎发病率差异有统计学意义(P<0.025)。头孢呋辛组与低浓度万古霉素组出现术后眼内炎患者临床表现无明显差异。术后眼内炎患者采用的治疗方案包括:前房冲洗+注药、玻璃体腔注药、玻璃体切割术、全身输注抗生素、局部激素/抗生素治疗。治疗后,低浓度万古霉素组视力均有提高,头孢呋辛组视力1例视力无提高,1例视力降低。两组患者均未行眼球摘除。结论白内障术毕前房注射低浓度万古霉素预防术后感染性眼内炎临床效果不劣于头孢呋辛。Objective To evaluate the clinical effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis in patients after cataract surgery.Methods We retrospectively collected the clinical data from 28845 patients undergoing cataract surgery in our hospital between January 2016 and December 2019,who received injection of low-concentration vancomycin(0.01 mg/mL,0.1 mL;13068 eyes in 7318 cases)or cefuroxime(10 mg/mL,0.1 mL;15777 eyes in 8935 cases)in the anterior chamber at the end of surgery for prevention of endophthalmitis.The patients’postoperative visual acuity,intraocular pressure,cornea,anterior chamber and intraocular lens under slit lamp,vitreous opacity with B-mode ultrasound,and laboratory culture results were analyzed to identify the patients with infectious endophthalmitis,and the treatments and outcomes of the patients were analyzed.Results The incidence of postoperative infectious endophthalmitis was 0.0229%(3 eyes in 3 cases)in low-concentration vancomycin group and 0.0127%(2 eyes in 2 cases)in cefuroxime group,showing a significant difference between the 2 groups(P<0.025).The results of bacterial culture identified cases of infections with Pseudomonas aeruginosa(1 case)and Staphylococcus epidermidis(2 cases)in low-concentration vancomycin group and infections with fungus(1 case)and Streptococcus mitis(1 case)in cefuroxime group.The clinical manifestations of infectious endophthalmitis in the identified cases did not differ significantly between the cefuroxime group and vancomycin group.The treatments of postoperative endophthalmitis included anterior chamber washing and drug injection,intravitreal drug injection,vitrectomy,systemic antibiotic infusion,and local hormone/antibiotic treatment.After the treatments,the visual acuity was improved in all cases in vancomycin group,but remained unchanged in one case and deteriorated in another in cefuroxime group.None of the patients required enucleation.Conclusion The clinical effect of low-concentration v

关 键 词：万古霉素 头孢呋辛 感染性眼内炎 

分 类 号：R771.2[医药卫生—眼科] R779.66[医药卫生—临床医学]