Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors.
Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors.
复制标题
角膜假体术后眼内炎：发病率、细菌原因和危险因素。
DOI：
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
C. Dohlman
中科院分区：
文献类型：
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作者：
M. Nouri;H. Terada;E. Alfonso;S. Foster;M. Durand;C. Dohlman
目标
目的：测定一组人工角膜患者的眼内炎发生率，并分析可能的危险因素。
方法
对1990~2000年间108例(108眼)双板式人工角膜手术患者的表面菌群、细菌性眼内炎或无菌玻璃体炎的发生率及原因、人工角膜的设计、预防性应用抗生素、伴随的免疫抑制及术前诊断等进行了分析。
结果
观察培养取自30只未感染的眼。植物区系与正常人群中报告的相似，并且没有随时间的显著变化。随访2个月~17年，平均3年4个月，术后2~46个月发生细菌性眼内炎13例。Stevens-Johnson综合征13例，瘢痕性类天疱疮27例，占19%，眼烧伤28例，占7%。在其他40例患者中，只有1例发生了眼内炎，这例患者有滤过泡。所有眼内炎病原菌均为革兰氏阳性：肺炎链球菌占23%，其他链球菌占39%，金黄色葡萄球菌占23%，表皮葡萄球菌占15%。
结论
这些人工角膜术后发生眼内炎的最重要的危险因素是术前诊断。Stevens-Johnson综合征和眼部瘢痕性类天疱疮的感染率很高，化学烧伤中等，非瘢痕性角膜疾病感染率低。
OBJECTIVES
To determine the rate of endophthalmitis in a group of patients with keratoprostheses and to analyze possible risk factors.
METHODS
A total of 108 patient eyes, operated on between 1990 and 2000 with double-plated keratoprostheses, were analyzed with regard to the surface flora, the incidence and cause of bacterial endophthalmitis or sterile vitreitis, the keratoprosthesis design, prophylactic antibiotics, concomitant immunosuppression, and preoperative diagnosis.
RESULTS
Surveillance cultures were obtained from 30 uninfected eyes. The flora was similar to that reported in the normal population and did not vary significantly with time. Thirteen cases of bacterial endophthalmitis occurred 2 to 46 months postoperatively in the patient population that had been followed up for 2 months to 17 years (average, 3 years 4 months). The incidence was 39% in 13 patients with Stevens-Johnson syndrome, 19% in 27 patients with ocular cicatricial pemphigoid, and 7% in 28 patients with ocular burns. Only 1 of the other 40 cases (consisting mostly of repeated graft failures in noncicatrizing conditions) developed endophthalmitis; this patient had a filtering bleb. All endophthalmitis pathogens were gram positive: Streptococcus pneumoniae, 23%; other streptococci, 39%; Staphylococcus aureus, 23%; and Staphylococcus epidermidis, 15%.
CONCLUSIONS
The most important risk factor for endophthalmitis after these keratoprostheses was found to be preoperative diagnosis. The rate of infection was very high in Stevens-Johnson syndrome and ocular cicatricial pemphigoid, moderate in chemical burns, and low in noncicatrizing corneal disease.