微创玻璃体切割手术后眼内炎_Chinese Journal of Ocular Fundus Diseases

Authors：

李梓敬 , 林静仪 ,  丁小燕

510060 广州, 中山大学中山眼科中心眼科学国家重点实验室;

Corresponding author：

丁小燕, Email: dingxy75@gmail.com

Keywords：

眼内炎/病因学; 外科手术, 微创性/副作用; 综述

DOI：

10.3760/cma.j.issn.1005-1015.2014.04.027

Video：

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微创玻璃体切割手术后眼内炎是发生在微创玻璃体视网膜手术后早期出现的感染性眼内炎。巩膜穿刺裂口不闭、低眼压、无眼内填充物、免疫抑制、手术后局部糖皮质激素使用、玻璃体束综合征、手术前准备不足、手术中辅助用药和手术时间长等为其相关的危险因素。致病菌以表皮葡萄球菌及凝固酶阴性葡萄球菌为主。药物治疗目前多选万古霉素和头孢他啶联合用药; 但这两种药物将有可能被利奈唑胺和替考拉宁逐渐取代。再次行玻璃体切割手术是其主要治疗手段。聚维酮碘、眼内灌注液手术前和手术中的合理使用在预防其发生方面有一定作用。

Citation： 李梓敬, 林静仪, 丁小燕. 微创玻璃体切割手术后眼内炎. Chinese Journal of Ocular Fundus Diseases, 2014, 30(4): 421-425. doi: 10.3760/cma.j.issn.1005-1015.2014.04.027 Copy

1.	Goncu T, Gurelik G, Hasanreisoglu B. Comparison of efficacy and safety between transconjunctival 23-gauge and conventional 20-gauge vitrectomy systems in macular surgery[J]. Korean J Ophthalmol, 2012, 26:339-346.
2.	王凡, 武志锋.微创玻璃体切割术研究进展[J].国际眼科纵览, 2010, 34:230-233.
3.	Shaikh S, Ho S, Richmond PP, et al. Untoward outcomes in 25-gauge versus 20-gauge vitreoretinal surgery[J]. Retina, 2007, 27:1048-1053.
4.	Kunimoto DY, Kaiser RS, Wills Eye Retina Service. Incidence of endophthalmitis after 20-and 25-gauge vitrectomy[J]. Ophthalmology, 2007, 114:2133-2137.
5.	Scott IU, Flynn HW Jr, Dev S, et al. Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes[J]. Retina, 2008, 28:138-142.
6.	Chen JK, Khurana RN, Nguyen QD, et al. The incidence of endophthalmitis following transconjunctival sutureless 25-vs 20-gauge vitrectomy[J]. Eye, 2009, 23:780-784.
7.	Eifrig CW, Scott IU, Flynn HW Jr, et al. Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes[J]. Am J Ophthalmol, 2004, 138:799-802.
8.	Parolini B, Romanelli F, Prigione G, et al. Incidence of endophthalmitis in a large series of 23-gauge and 20-gauge transconjunctival pars plana vitrectomy[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247:895-898.
9.	Scott IU, Flynn HW, Acar N, et al. Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy[J]. Graefe's Arch Clin Experim Ophthalm, 2011, 249:377-380.
10.	Park JC, Ramasamy B, Shaw S, et al. A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: incidence and risk factors[J]. Br J Ophthalmol, 2014, 98:529-533.
11.	Bahrani HM, Fazelat AA, Thomas M, et al. Endophthalmitis in the era of small gauge transconjunctival sutureless vitrectomy: meta analysis and review of literature[J]. Semin Ophthalmol, 2010, 25:275-282.
12.	Chisari G. Endophthalmitis: gram positive ethiological agents and susceptibility to glycopeptides[J]. Curr Clin Pharmacol, 2008, 3:153-155.
13.	翁益平, 王桂云, 左玲.玻璃体切割手术后眼内炎的临床诊治进展[J].中华眼底病杂志, 2012, 28:203-205.
14.	邵清, 樊莹.微创手术后眼内炎[J].中华眼外伤职业眼病杂志, 2011, 33:718-720.
15.	Taban M, Ufret-Vincenty RL, Sears JE. Endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2006, 26:830-831.
16.	Yan H, Li J. An experimental study on antimicrobial activity of silicone oil in vitro[J]. Ophthalmologica, 2008, 222:245-248.
17.	段蔚.手术后眼内炎危险因素的分析[J].中华医院感染学杂志, 2003, 13:130.
18.	Gupta OP, Maguire JI, Eagle RC Jr, et al. The competency of pars plana vitrectomy incisions: a comparative histologic and spectrophotometric analysis[J]. Am J Ophthalmol, 2009, 147:243-250.
19.	Nam DH, Ku M, Sohn HJ, et al. Minimal fluid-air exchange in combined 23-gauge sutureless vitrectomy, phacoemulsification, and intraocular lens implantation[J]. Retina, 2010, 30:125-130.
20.	Schweitzer C, Delyfer MN, Colin J, et al. 23-Gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study[J]. Eye (Lond), 2009, 23:2206-2214.
21.	Siqueira RC, Gil AD, Canamary F, et al. Pars plana vitrectomy and silicone oil tamponade for acute endophthalmitis treatment[J]. Arq Bras Oftalmol, 2009, 72:28-32.
22.	Rouw J, Shaver JF. Vitreous wicking syndrome as a complication of extracapsular cataract extraction[J]. Optometry, 2008, 79:193-196.
23.	Venkatesh P, Verma L, Tewari H. Posterior vitreous wick syndrome: a potential cause of endophthalmitis following vitreo-retinal surgery[J]. Med Hypotheses, 2002, 58:513-515.
24.	孙英, 姜鹏飞.玻璃体切除术后感染性眼内炎3例[J].国际眼科杂志, 2010, 10:1452.
25.	Speaker MG, Milch FA, Shah MK, et al.Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis[J]. Ophthalmology, 1991, 98:639-650.
26.	Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery[J]. Ophthalmology, 2002, 109:1807-1813.
27.	Javitt JC, Street DA, Tielsch JM, et al. National outcomes of cataract extraction: retinal detachment and endophthalmitis after outpatient cataract surgery[J]. Ophthalmology, 1994, 101:100-106.
28.	Kattan HM, Flynn HW Jr, Pflugfelder SC, et al. Nosocomial endophthalmitis survey: current incidence of infection after intraocular surgery[J]. Ophthalmology, 1991, 98:227-238.
29.	López-Cabezas C, Muner DS, Massa MR, et al. Antibiotics in endophthalmitis: microbiological and pharmacokinetic considerations[J]. Curr Clin Pharmacol, 2010, 5:47-54.
30.	黎晓新, 张正.眼内炎的诊断与处理及预防[J].中华眼科杂志, 2006, 42:946-950.

1. Goncu T, Gurelik G, Hasanreisoglu B. Comparison of efficacy and safety between transconjunctival 23-gauge and conventional 20-gauge vitrectomy systems in macular surgery[J]. Korean J Ophthalmol, 2012, 26:339-346.
2. 王凡, 武志锋.微创玻璃体切割术研究进展[J].国际眼科纵览, 2010, 34:230-233.
3. Shaikh S, Ho S, Richmond PP, et al. Untoward outcomes in 25-gauge versus 20-gauge vitreoretinal surgery[J]. Retina, 2007, 27:1048-1053.
4. Kunimoto DY, Kaiser RS, Wills Eye Retina Service. Incidence of endophthalmitis after 20-and 25-gauge vitrectomy[J]. Ophthalmology, 2007, 114:2133-2137.
5. Scott IU, Flynn HW Jr, Dev S, et al. Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes[J]. Retina, 2008, 28:138-142.
6. Chen JK, Khurana RN, Nguyen QD, et al. The incidence of endophthalmitis following transconjunctival sutureless 25-vs 20-gauge vitrectomy[J]. Eye, 2009, 23:780-784.
7. Eifrig CW, Scott IU, Flynn HW Jr, et al. Endophthalmitis after pars plana vitrectomy: Incidence, causative organisms, and visual acuity outcomes[J]. Am J Ophthalmol, 2004, 138:799-802.
8. Parolini B, Romanelli F, Prigione G, et al. Incidence of endophthalmitis in a large series of 23-gauge and 20-gauge transconjunctival pars plana vitrectomy[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247:895-898.
9. Scott IU, Flynn HW, Acar N, et al. Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy[J]. Graefe's Arch Clin Experim Ophthalm, 2011, 249:377-380.
10. Park JC, Ramasamy B, Shaw S, et al. A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy: incidence and risk factors[J]. Br J Ophthalmol, 2014, 98:529-533.
11. Bahrani HM, Fazelat AA, Thomas M, et al. Endophthalmitis in the era of small gauge transconjunctival sutureless vitrectomy: meta analysis and review of literature[J]. Semin Ophthalmol, 2010, 25:275-282.
12. Chisari G. Endophthalmitis: gram positive ethiological agents and susceptibility to glycopeptides[J]. Curr Clin Pharmacol, 2008, 3:153-155.
13. 翁益平, 王桂云, 左玲.玻璃体切割手术后眼内炎的临床诊治进展[J].中华眼底病杂志, 2012, 28:203-205.
14. 邵清, 樊莹.微创手术后眼内炎[J].中华眼外伤职业眼病杂志, 2011, 33:718-720.
15. Taban M, Ufret-Vincenty RL, Sears JE. Endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2006, 26:830-831.
16. Yan H, Li J. An experimental study on antimicrobial activity of silicone oil in vitro[J]. Ophthalmologica, 2008, 222:245-248.
17. 段蔚.手术后眼内炎危险因素的分析[J].中华医院感染学杂志, 2003, 13:130.
18. Gupta OP, Maguire JI, Eagle RC Jr, et al. The competency of pars plana vitrectomy incisions: a comparative histologic and spectrophotometric analysis[J]. Am J Ophthalmol, 2009, 147:243-250.
19. Nam DH, Ku M, Sohn HJ, et al. Minimal fluid-air exchange in combined 23-gauge sutureless vitrectomy, phacoemulsification, and intraocular lens implantation[J]. Retina, 2010, 30:125-130.
20. Schweitzer C, Delyfer MN, Colin J, et al. 23-Gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study[J]. Eye (Lond), 2009, 23:2206-2214.
21. Siqueira RC, Gil AD, Canamary F, et al. Pars plana vitrectomy and silicone oil tamponade for acute endophthalmitis treatment[J]. Arq Bras Oftalmol, 2009, 72:28-32.
22. Rouw J, Shaver JF. Vitreous wicking syndrome as a complication of extracapsular cataract extraction[J]. Optometry, 2008, 79:193-196.
23. Venkatesh P, Verma L, Tewari H. Posterior vitreous wick syndrome: a potential cause of endophthalmitis following vitreo-retinal surgery[J]. Med Hypotheses, 2002, 58:513-515.
24. 孙英, 姜鹏飞.玻璃体切除术后感染性眼内炎3例[J].国际眼科杂志, 2010, 10:1452.
25. Speaker MG, Milch FA, Shah MK, et al.Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis[J]. Ophthalmology, 1991, 98:639-650.
26. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery[J]. Ophthalmology, 2002, 109:1807-1813.
27. Javitt JC, Street DA, Tielsch JM, et al. National outcomes of cataract extraction: retinal detachment and endophthalmitis after outpatient cataract surgery[J]. Ophthalmology, 1994, 101:100-106.
28. Kattan HM, Flynn HW Jr, Pflugfelder SC, et al. Nosocomial endophthalmitis survey: current incidence of infection after intraocular surgery[J]. Ophthalmology, 1991, 98:227-238.
29. López-Cabezas C, Muner DS, Massa MR, et al. Antibiotics in endophthalmitis: microbiological and pharmacokinetic considerations[J]. Curr Clin Pharmacol, 2010, 5:47-54.
30. 黎晓新, 张正.眼内炎的诊断与处理及预防[J].中华眼科杂志, 2006, 42:946-950.

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微创玻璃体切割手术后眼内炎

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