Rates and Risk Factors for Endophthalmitis After Cataract Surgery

描述(由申请人提供)：白内障手术是美国最常见的手术，在过去的20年里经历了实质性的技术改进。一般认为，伤口越小，手术时间越短，视力和活动能力恢复越快，术后眼内炎的发生率就越低，而眼内炎可能是最重要的手术并发症。我们展示的初步研究有力地表明，在过去的十年中，这一比例一直在上升，年龄和黑人种族是重要的风险因素。眼内炎流行病学的文献主要局限于小规模和区域性研究。这些都表明手术因素，如位置(即。角膜与巩膜)和闭合(即。伤口的使用与不使用缝合)以及围手术期抗生素使用的强度和时机可能很重要。我们建议通过识别和验证从医疗保险数据文件中确定的眼内炎病例来确定白内障手术后急性眼内炎的全国代表性比率。然后，我们将在一项基于人群的病例对照研究中，通过检查来自同一医疗保险基础的392例病例和1176名对照的潜在危险因素，试图确定眼内炎的患者和手术危险因素。研究人员希望找出可以修改的因素，以降低眼内炎的发生率，并提供有助于规划未来干预试验的信息。

DESCRIPTION (provided by applicant): Cataract surgery, the most commonly performed procedure in the United States, has undergone substantial technologic improvements over the past 20 years. One would anticipate that the smaller wounds, shorter operative time, and more rapid visual and ambulatory recovery would be associated with a reduction in the rate of postoperative endophthalmitis, perhaps the most significant operative complication. We show preliminary research that strongly suggests that the rate has been increasing over the past decade and that age and black race are important risk factors. The literature on the epidemiology of endophthalmitis is largely limited to small and regional studies. These suggest that surgical factors such as the location (ie. corneal vs scleral) and closure (ie. use vs non-use of stitch) of the wound may be important as well as intensity and timing of perioperative antibiotic use. We propose to ascertain nationally representative rates of acute endopthalmitis following cataract surgery by identifying and verifying cases of endophthalmitis ascertained from Medicare data files. We will then try to identify patient and surgical risk factors for endopthalmitis in a population-based case-control study by examining potential risk factors in 392 cases and 1176 controls drawn from the same Medicare base. The investigators hope to identify factors that can be modified to lower the rate of endopthalmitis and to provide information that would facilitate planning for future interventional trials.