Post-traumatic endophthalmitis
Post-traumatic endophthalmitis
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DOI：
10.1016/j.ophtha.2003.09.041
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发表时间：
2004-11-01
期刊：
影响因子：
13.7
通讯作者：
Allen, PJ
中科院分区：
文献类型：
--
作者：
Essex, RW;Yi, Q;Allen, PJ
目的：建立外伤后眼内炎发生的危险因素，观察预防措施的有效性，描述外伤后眼内炎的临床特点。设计：部分前瞻性连续病例对照研究。研究对象：纳入一家眼科医院3年来连续收治的250例开放性眼内炎患者。方法：对外伤后眼内炎患者进行前瞻性鉴定，纳入眼内炎数据库。所有在同一时间段内的开放性眼球损伤通过对住院患者的回顾搜索来确定，并回顾它们的图表。从所有患者档案中收集的信息包括：患者年龄；性别；损伤环境(室内/室外)；伤口污染；损伤性质(眼睛部位、晶状体受累、眼内残留异物)；损伤机制(穿透/穿孔/破裂/破裂的手术伤口)；预防性抗生素应用，包括路线和时机；初次修复的时间；初次修复时的晶状体切除术；以及初次修复时的储存皮质类固醇。研究了这些参数与随后发生的眼内炎之间的任何联系。评估眼内炎与最终视力(VA)和眼球摘除之间的关系。主要观察指标：眼内炎的发生。结果：开放眼球损伤后眼内炎的发生率为6.8%。单因素分析显示：伤口脏器(14.3%比4.1%，P=0.01)、眼内异物滞留(13.0%比4.4%，P=0.02)、晶状体囊膜破裂(12.8%比3.2%，P=0.01)、初次修补延迟12小时(11.3%比2.9%，P=0.02)、农村住址(10.1%比4.3%，P=0.07)与眼内炎的发生有关。多因素分析确定的危险因素有脏伤(优势比OR 5.3；95%可信区间[CI]1.5~18.7)、晶状体囊膜破裂(OR 4.4；95%CI 1.2~15.6)、初次修复延迟(每小时OR 1.013；95%CI 1.002~1.024)。未发现以下因素与外伤性眼内炎有关：患者年龄、性别、损伤环境、眼损伤部位、损伤机制、抗生素应用、初次修复时的晶状体切除术和初次修复时的储备皮质类固醇。有眼内炎的患者最终视力更差(P=0.08)。眼内炎对眼球摘除的发生率无显著影响(5.9%vs.4.3%，P=0.55)。结论：一期修复延迟、晶状体囊膜破裂和伤口肮脏均与外伤性眼内炎的发生独立相关。这3个危险因素中有2个的患者感染频率特别高。(C)2004年，由美国眼科学会提供。
Objective: To establish risk factors for the occurrence of post-traumatic endophthalmitis, to observe the efficacy of prophylaxis, and to describe the clinical features of post-traumatic endophthalmitis.Design: Partially prospective consecutive case-control study.Participants: A total of 250 consecutive patients admitted to a single ophthalmic hospital with open globe injuries during a 3-year period were included.Methods: Patients with post-traumatic endophthalmitis were identified prospectively and added to an endophthalmitis database. All open globe injuries during the same time period were identified through a retrospective search of inpatient admissions, and their charts were reviewed. Information collected from all patient files included patient age; gender; injury setting (indoor/outdoor); wound contamination; nature of injury (site on eye, lens involvement, retained intraocular foreign body); mechanism of injury (penetration/perforation/ rupture/ruptured surgical wound); prophylactic antibiotic administration, including route and timing; timing of primary repair; lensectomy at the time of primary repair; and depot corticosteroid at the time of primary repair. Any association between these parameters and the subsequent development of endophthalmitis was investigated. Any association between endophthalmitis and final visual acuity (VA) and also enucleation was evaluated.Main Outcome Measure: Development of endophthalmitis.Results: The frequency of endophthalmitis after open globe injury was 6.8%. The following factors were associated with the subsequent development of endophthalmitis by univariate analysis: dirty wound (14.3% vs. 4.1 %, P = 0.01), retained intraocular foreign body (13.0% vs. 4.4%, P = 0.02), lens capsule breach (12.8% vs. 3.2%, P = 0.01), delayed primary repair (= 12 hours) (11.3% vs. 2.9%, P = 0.02), and rural address (10.1 % vs. 4.3%, P = 0.07). Risk factors identified after multivariate analysis were dirty injury (odds ratio [OR], 5.3; 95% confidence interval [CI)], 1.5-18.7), breach of lens capsule (OR, 4.4; 95% CI, 1.2-15.6), and delay in primary repair (per hour: OR, 1.013; 95% CI, 1.002-1.024). None of the following factors was found to be associated with post-traumatic endophthalmitis: patient age, gender, injury setting, site of injury on eye, mechanism of injury, antibiotic administration, lensectomy at the time of primary repair, and depot corticosteroid at the time of primary repair. Final VA tended to be worse in eyes with endophthalmitis (P = 0.08). Endophthalmitis did not significantly influence the frequency of enucleation/evisceration (5.9% vs. 4.3%, P = 0.55).Conclusions: Delay in primary repair, ruptured lens capsule, and dirty wound were each independently associated with the development of post-traumatic endophthalmitis. Patients with :2 of these 3 risk factors had a particularly high frequency of infection. (C) 2004 by the American Academy of Ophthalmology.