在未进行微生物培养的情况下处理白内障手术后眼底病的效果。

IF 4.4 Q1 OPHTHALMOLOGY

Ophthalmology. Retina Pub Date : 2025-01-01 DOI:10.1016/j.oret.2024.07.015

Annika G. Samuelson MD , Samir N. Patel MD , Kapila Kommareddy MD , Bita Momenaei MD , Eugene Yu-Chuan Kang MD , Varun Chaudhary MD , Jason Hsu MD , James P. Dunn MD , James F. Vander MD , Sunir J. Garg MD

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引用次数: 0

摘要

目的：评估未经微生物培养处理的白内障手术后眼内炎患者的治疗效果：这项回顾性、单中心比较队列研究确定了2014年2月1日至2022年11月1日期间所有白内障手术后眼内炎病例：纳入所有推测患有眼内炎、需要在诊室内使用玻璃体内抗生素和玻璃体或眼水穿刺治疗的眼睛：如果玻璃体或水样标本被送去进行微生物采样，则眼内炎病例被分为 "培养组"；如果进行了水样或玻璃体穿刺，但未送去进行微生物采样，则眼内炎病例被分为 "无培养组"：眼底病发生后12个月的最佳矫正视力（VA）、视网膜脱离发生率以及后续手术需求：在确定的 232 例眼底病病例中，196 例（85%）属于 "培养组"，36 例（15%）属于 "无培养组"。在出现眼底病时，"培养组 "眼睛的平均（标清）logMAR VA [斯奈伦等值] 为 2.14 (0.8) [20/2760]，而 "无培养组 "眼睛的平均（标清）logMAR VA 为 1.93 (0.8) [20/1702]（P=0.185）。随访 12 个月时，"培养组 "的平均（标清）logMAR VA 为 0.80 (1.0) [20/126] ，"无培养组 "为 0.41 (0.5) [20/50] （调整后差异 = 0.41，95% CI = -0.043 - 0.857，p=0.076）。培养组 "的196只眼睛中有20只（10%）在发病后12个月内发生继发性视网膜脱离，而 "无培养组 "为0只（P=0.045）：结论：白内障手术后发生眼内炎而未进行微生物培养的患者，其视觉效果与进行微生物培养的患者相似，而且发生继发性视网膜脱离的可能性较小。在无法及时进入微生物设施的情况下，这可能是处理白内障手术后眼内炎的一种可接受的策略。

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Outcomes of Postcataract Surgery Endophthalmitis Managed Without Microbial Cultures

Purpose

To evaluate outcomes of eyes with postcataract surgery endophthalmitis that were managed without microbial cultures.

Design

This retrospective, single-center comparative cohort study identified all cases of endophthalmitis after cataract surgery presenting between February 1, 2014, and November 1, 2022.

Subjects

All eyes presenting with presumed endophthalmitis requiring in-office treatment with intravitreal antibiotics and either a vitreous or aqueous tap were included.

Methods

Endophthalmitis cases were divided into the “culture group,” if the vitreous or aqueous specimens were sent for microbiologic sampling, or into the “no culture group” if an aqueous or vitreous tap was performed but not sent for microbiologic sampling.

Main Outcome Measures

Best-corrected visual acuity (VA) 12 months after endophthalmitis presentation, incidence of retinal detachment, and need for subsequent procedures.

Results

Of the 232 endophthalmitis cases identified, 196 (85%) were in the “culture group” and 36 (15%) were in the “no culture group.” At endophthalmitis presentation, eyes in the “culture group” had a mean (standard deviation [SD]) logarithm of the minimum angle of resolution (logMAR) VA (Snellen equivalent) of 2.14 (0.8) (20/2760) and mean (SD) logMAR VA in the “no culture group” was 1.93 (0.8) (20/1702) (P = 0.185). At 12-month follow-up, mean (SD) logMAR VA for the “culture group” was 0.80 (1.0) (20/126) and 0.41 (0.5) (20/50) in the “no culture group” (adjusted difference = 0.41, 95% confidence interval = −0.043 to 0.857, P = 0.076). Twenty of 196 (10%) eyes in the “culture group” developed secondary retinal detachments within 12 months of presentation compared with 0 in the “no culture group” (P = 0.045).

Conclusions

Eyes with endophthalmitis after cataract surgery managed without microbiologic cultures have similar visual outcomes to eyes managed with microbiologic cultures and may be less likely to develop secondary retinal detachments. This may be an acceptable strategy to manage endophthalmitis after cataract surgery when prompt access to a microbiologic facility is unavailable.