Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group.
Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group.
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目的探讨玻璃体切除术（VIT）联合全身抗生素治疗在眼内炎术后的作用。设计研究者发起的多中心随机临床试验。背景私人和大学为基础的视网膜玻璃体的做法。患者共有420名患者在白内障手术或二期人工透镜植入术后6周内出现眼内炎的临床证据。干预根据2 × 2析因设计随机分配到VIT或玻璃体穿刺或活检（TAP）治疗组和全身性抗生素（头孢他啶和阿米卡星）治疗组。主要观察指标：通过早期治疗糖尿病视网膜病变研究视力表评估的9个月视力评估，以及临床和手术评估的中膜清晰度。结果使用或不使用全身抗生素的最终视力或介质清晰度没有差异。在初始视力为手部运动或更好的患者中，无论是否立即进行VIT，视力结果没有差异。然而，在初始光感知仅视力的患者亚组中，VIT使达到20/40或更好视力的频率增加了三倍（33%对11%），达到20/100或更好视力的机会增加了大约两倍（56%对30%），严重视力丧失的频率降低了50%（20%对47%）。在这组患者中，在整个视力范围内，VIT和TAP之间的差异具有统计学意义（P <0.001，累积视力评分的对数秩检验）。结论：省略全身抗生素治疗可以减少毒性反应、费用和住院时间。常规立即VIT对于就诊时视力优于光感的患者没有必要，但对于仅具有光感视力的患者有实质性益处。
OBJECTIVE To determine the roles of immediate pars plana vitrectomy (VIT) and systemic antibiotic treatment in the management of postoperative endophthalmitis. DESIGN Investigator-initiated, multicenter, randomized clinical trial. SETTING Private and university-based retina-vitreous practices. PATIENTS A total of 420 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery or secondary intraocular lens implantation. INTERVENTIONS Random assignment according to a 2 x 2 factorial design to treatment with VIT or vitreous tap or biopsy (TAP) and to treatment with or without systemic antibiotics (ceftazidime and amikacin). MAIN OUTCOME MEASURES A 9-month evaluation of visual acuity assessed by an Early Treatment Diabetic Retinopathy Study acuity chart and media clarity assessed both clinically and photographically. RESULTS There was no difference in final visual acuity or media clarity with or without the use of systemic antibiotics. In patients whose initial visual acuity was hand motions or better, there was no difference in visual outcome whether or not an immediate VIT was performed. However, in the subgroup of patients with initial light perception-only vision, VIT produced a threefold increase in the frequency of achieving 20/40 or better acuity (33% vs 11%), approximately a twofold chance of achieving 20/100 or better acuity (56% vs 30%), and a 50% decrease in the frequency of severe visual loss (20% vs 47%) over TAP. In this group of patients, the difference between VIT and TAP was statistically significant (P < .001, log rank test for cumulative visual acuity scores) over the entire range of vision. CONCLUSIONS Omission of systemic antibiotic treatment can reduce toxic effects, costs, and length of hospital stay. Routine immediate VIT is not necessary in patients with better than light perception vision at presentation but is of substantial benefit for those who have light perception-only vision.