眼内异物相关眼内炎的临床特征与预后分析  

Clinical features and prognosis of intraocular foreign body with endophthalmitis

作　　者：陈豪 金一帆 魏文龙 赵振全 魏勇 Chen Hao;Jin Yifan;Wei Wenong;Zhao Zhenquan;Wei Yong(Eye Hospital,Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属眼视光医院、国家眼耳鼻喉疾病临床医学研究中心(眼部疾病),温州325027

出　　处：《中华眼底病杂志》2025年第4期282-288,共7页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察眼内异物相关眼内炎患者的临床特征和治疗结局,分析影响患者解剖和视力结局的因素。方法回顾性临床研究。2015年1月至2024年6月于温州医科大学附属眼视光医院检查确诊的眼内异物患者1704例1704只眼中相关眼内炎患者263例263只眼(15.4%,263/1704),排除手术后资料不全者,最终155例155只眼纳入研究。手术前均行裸眼视力(UCVA)检查;一期清创缝合手术后及随访期间均行最佳矫正视力(BCVA)检查。视力检查采用标准对数视力表进行,统计时换算为最小分辨角对数(logMAR)视力。记录患者人口学特征(性别、年龄)、外伤特征(受伤时间、职业特点、异物性质)、解剖损伤特征(伤口分区、感染性质等)、临床救治特征(手术距受伤时间、二次手术率等)及转归特征(视力转归、并发症、解剖结局等)。2022年开始在围手术期全身给予头孢唑林钠基础上,预防性给予玻璃体腔注射10 mg/ml的头孢唑林钠0.1 ml(含头孢唑林钠1 mg)。解剖结局包括解剖复位、硅油依赖、眼球摘除;视力结局为末次随访时BCVA<0.05、0.05~0.3、>0.3。手术后随访时间(11.3±13.3)个月。采用广义线性混合模型(GLMM)分析治疗时机、异物性质、感染性质、手术次数、受伤位置等与解剖结局和视力结局的相关性。结果155例155只眼中,男性149例,女性6例;年龄(45.7±12.9)岁;均为单眼受伤。磁性、非磁性、性质不明金属以及植物性、矿物质、动物性、性质不明异物分别为102(65.8%,102/155)、2(1.3%,2/155)、28(18.1%,28/155)、1(0.6%,1/155)、12(7.7%,12/155)、7(4.5%,7/155)、3(1.9%,3/155)例。受伤距异物取出时间为(98.1±359.5)h。一期手术取出异物者136只眼(87.2%,136/155)。其中,玻璃体切割手术(PPV)68只眼;非PPV联合清创缝合67只眼;眼球摘除1只眼。涂片及培养结果显示,细菌、细菌真菌混合阳性者分别为80(51.2,80/155)、2(1.3%。2/155)只眼;阴性者73只眼(46.8%,73/Objective To observe the clinical features and treatment outcomes of patients with intraocular foreign bodies with endophthalmitis,and analyze the prognostic factors affecting the anatomic and visual outcomes of patients.Methods A retrospective clinical study.A total of 1704 patients(1704 eyes)with intraocular foreign body at Eye Hospital,Wenzhou Medical University from January 2015 to June 2024 were included in this study.Endophthalmitis was diagnosed in 263 eyes(15.4%,263/1704).Patients who lost followup in our hospital after surgery were excluded,155 patients with 155 eyes were finally included in the study.Uncorrected visual acuity(UCVA)examination was performed before operation.Best corrected visual acuity(BCVA)examination was performed both after the first stage debridement and during follow-up.The visual acuity test is performed using a standard logarithmic visual acuity chart,which is statistically converted to logarithm of the minimum angle of resolution(logMAR)visual acuity.Demographic characteristics(gender,age),trauma characteristics(time of injury,occupation characteristics,nature of foreign body),anatomical injury(wound zoning,nature of infection,etc.),clinical treatment(interval between operation and injury,rate of second operation,etc.)and outcome(vision outcome,complications,anatomic outcome,etc.)were recorded.Prophylactic intravitreous injection of 10 mg/ml of cefazolin sodium 0.1 ml(including 1 mg of cefazolin sodium)was given on the basis of perioperative systemic administration of cefazolin sodium from 2022.Anatomical outcomes included anatomical reduction,silicone oil-dependent,and ophthalmectomy.The visual outcomes of the patients were categorized into three groups based on the best-corrected visual acuity at the final follow-up:visual acuity worse than 0.05,visual acuity between 0.05 and 0.3,and visual acuity better than 0.3.Generalized linear mixed model(GLMM)was used to analyze the correlation between the timing of treatment,nature of foreign body,nature of infection,number of operations

关 键 词：眼内异物 眼内炎 临床特征 解剖结局 视力结局 

分 类 号：R779.1[医药卫生—眼科]