玻璃体内注射万古霉素预防Ⅱ区眼球穿孔伤术后眼内炎的临床研究  

Clinical study on intravitreal injection of vancomycin for preventing endophthalmitis after zoneⅡocular penetrating injury surgery

作　　者：韩少磊 王婷婷 温媛 贾金辰 范怡明 Han Shaolei;Wang Tingting;Wen Yuan;Jia Jinchen;Fan Yiming(Department of Ocular Trauma,Hebei Eye Hospital,Xingtai 054001,China)

机构地区：[1]河北省眼科医院眼外伤科,邢台054001

出　　处：《中华眼外伤职业眼病杂志》2024年第12期938-942,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

基　　金：邢台市重点研发计划自筹项目(2022ZC173)。

摘　　要：目的评价玻璃体内注射万古霉素预防Ⅱ区眼球穿孔伤术后眼内炎的临床效果。方法回顾性队列研究。纳入河北省眼科医院2017年1月至2022年12月Ⅱ区眼球穿孔伤患者172例(172眼)作为观察组,观察组在一期手术结束时玻璃体内注射1 mg/0.1 mL万古霉素;另纳入2014年1月至2016年12月的Ⅱ区眼球穿孔伤患者78例(78眼)作为对照组,单纯急诊行手术治疗。观察术后2周内两组患者眼内炎发生率,眼内炎症指标,手术前后视力变化及高眼压、角膜水肿等并发症情况。术后随访6个月。结果观察组术后2周有4例(4眼)发生眼内炎,发生率为3.3%(4/172);对照组有8例(8眼)发生眼内炎,发生率为10.3%(8/78),两组相比差异有统计学意义(χ^(2)=7.37,P<0.001)。观察组术后2周房水闪光评分[1(0,1)分]低于对照组[1(1,2)分],差异有统计学意义(Z=-6.68,P<0.001)。观察组术后6个月最佳矫正视力(logMAR)0.39±0.22优于对照组0.53±0.26,差异有统计学意义(t=5.86,P<0.001)。观察组并发症发生率为3.5%(6/172),对照组为5.1%(4/78),差异无统计学意义(χ^(2)=0.38,P=0.530)。结论玻璃体内注射万古霉素能有效预防Ⅱ区眼球穿孔伤术后眼内炎的发生,提高视力恢复效果,减轻眼内炎症反应,且安全性良好。Objective To evaluate the clinical efficacy of intravitreal injection of vancomycin for preventing postoperative endophthalmitis following zoneⅡocular penetrating injury repair.Methods A retrospective cohort study was conducted.A total of 172 eyes of 172 patients with zoneⅡocular penetrating injuries treated at the Hebei Eye Hospital from January 2017 to December 2022 were included as the observation group,which received an intravitreal injection of 1 mg/0.1 mL vancomycin at the end of the primary surgery.Another 78 eyes from 78 patients with zoneⅡocular penetrating injuries treated from January 2014 to December 2016 were included as the control group,which underwent emergency surgery only.The incidence of endophthalmitis within 2 weeks postoperatively,intraocular inflammatory markers,changes in visual acuity before and after surgery,and complications such as high intraocular pressure and corneal edema were compared between the two groups.The follow-up time was 6 months after surgery.Results At 2 weeks postoperatively,4 eyes(4/172,3.3%)in the observation group developed endophthalmitis,compared with the 8 eyes(8/78,10.3%)in the control group.The difference was statistically significant(χ^(2)=7.37,P<0.001).Aqueous flare score at 2 weeks postoperatively was lower in the observation group[1(0,1)]than in the control group[1(1,2)],with a statistically significant difference(Z=-6.68,P<0.001).Best-corrected visual acuity(logMAR)at 6 months postoperatively was better in the observation group(0.39±0.22)than that in the control group(0.53±0.26),with a statistically significant difference(t=5.86,P<0.001).The incidence of complications was 3.5%(6/172)in the observation group and 5.1%(4/78)in the control group,with no statistically significant difference(χ^(2)=0.38,P=0.530).Conclusion Intravitreal injection of vancomycin effectively prevents postoperative endophthalmitis in zoneⅡocular penetrating injuries,improves visual outcome,reduces intraocular inflammation,and demonstrates good safety profile.

关 键 词：眼损伤 穿透性 眼内炎 玻璃体内注射 万古霉素 预防 

分 类 号：R47[医药卫生—护理学]