Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis
Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis
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DOI：
10.22608/apo.2018414
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Chang, Andrew A.
中科院分区：
文献类型：
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作者：
Ho, I-Van;Fernandez-Sanz, Guillermo;Chang, Andrew A.
目的：评价早期平坦部玻璃体切割术(PPV)治疗急性感染性眼内炎的有效性和安全性，寻找视力改善的预后因素。设计：回顾性队列研究。方法：纳入2009年1月至2013年12月在澳大利亚新南威尔士州一家大型三级转诊中心接受早期PPV治疗的急性感染性细菌性眼内炎患者。检查从基线到1年最佳矫正视力(VA)的变化。结果：共纳入患者。诱发事件为白内障手术(53%)、玻璃体内注射(36%)、小梁切除术(3%)和内源性手术(3%)。平均视力从基线时的3.1logMAR(手运动)改善到1年的1.02logMAR(约20/200)，其中42%的患者在术后早期达到或超过0.477 logMAR(20/60)。积极的预后因素是细菌培养阴性(P<；0.01)和白内障手术后的病因(P<；0.01)。在调整年龄和预后因素的多变量分析中，光感知和手部运动基线视力的患者比数指患者获得了更大的视觉增益，对数值MAR分别为-2.68、-2.09和-0.85(P<；0.0001)。白内障手术后微生物培养阴性和眼内炎与较好的最终视力结果相关。有光感或手部运动的VA患者比那些有计数手指的患者获得了更高的视觉增益，这表明早期PPV可能对两组都有利。
Purpose: To evaluate the efficacy and safety of early pars plana vitreetomy (PPV) for the treatment of acute infective endophthalmitis, find identify prognostic factors for better visual outcome.Design: Retrospective cohort study.Methods: Consecutive patients who underwent early PPV within 72 hours of presentation for the treatment of acute infective bacterial endophthalmitis and presented to a large tertiary referral center in New South Wales, Australia, between January 2009 and December 2013 were included. Changes in best-corrected visual acuity (VA) from baseline to 1 year were examined.Results: A total of 64 patients were included. The inciting events were cataract surgery (53%), intravitreal injection (36%), trabeculectomy (3%), and endogenous (3%). The mean VA improved from 3.1 logMAR (hand motion) at baseline to 1.02 (approximately 20/200) at 1 year, with 42% achieving final VA equal to or better than 0.477 logMAR (20/60) following early PPV. Positive prognostic factors were negative microbial cultures (P < 0.01) and etiology of post-cataract surgery (P < 0.01). In multivariable analyses adjusting for age and prognostic factors, patients with baseline VA of light perception and hand motion achieved greater visual gains than those with counting fingers, with gains of logMAR of -2.68, -2.09, and -0.85, respectively (P < 0.0001).Conclusion: Most patients who undergo early PPV experience substantial VA improvement. Negative microbial cultures and endophthalmitis after cataract surgery were associated with better final visual outcome. Patients with presenting VA of light perception or hand motion achieved higher visual gains than those with counting fingers, suggesting the possibility that early PPV may be beneficial in both groups.