前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析

陶栗; 刘玮; 叶剑

doi:10.16016/j.1000-5404.202005210

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前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析

临床医学 | 更新时间：2026-01-09

- 前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析
- Effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis after cataract surgery
- 第三军医大学学报 2020年42卷第20期页码：2057-2062
- 作者机构：
  
  400042 重庆，陆军军医大学(第三军医大学)大坪医院眼科
- 作者简介：
  
  [叶剑，E-mail:yejian1979@163.com YE Jian, E-mail: yejian1979@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202005210
  中图分类号： R771.2;R779.66;R978.12
- 收稿：2020-05-23，
  
  修回：2020-08-07，
  
  纸质出版：2020-10-30
- 稿件说明：
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陶栗, 刘玮, 叶剑. 前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析[J]. 第三军医大学学报, 2020,42(20):2057-2062.

Li TAO, Wei LIU, Jian YE. Effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis after cataract surgery[J]. Journal of Third Military Medical University, 2020, 42(20): 2057-2062.
陶栗, 刘玮, 叶剑. 前房注射低浓度万古霉素预防白内障术后感染性眼内炎的临床效果分析[J]. 第三军医大学学报, 2020,42(20):2057-2062. DOI： 10.16016/j.1000-5404.202005210.

Li TAO, Wei LIU, Jian YE. Effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis after cataract surgery[J]. Journal of Third Military Medical University, 2020, 42(20): 2057-2062. DOI： 10.16016/j.1000-5404.202005210.

摘要

目的

探讨低浓度万古霉素预防白内障术后感染性眼内炎的临床效果。

方法

收集2016-2019年于我院行白内障手术的28 845例患者病历资料，根据术毕前房使用药物分为低浓度万古霉素组(0.01 mg/mL，0.1 mL)及头孢呋辛组(10 mg/mL，0.1 mL)。回顾性分析术后患者视力、眼压、角膜，裂隙灯下角膜、前房、人工晶体情况，B超下玻璃体混浊情况，实验室微生物培养情况，已确诊感染性眼内炎患者，分析眼内炎患者的治疗方案及预后。

结果

共发现感染性眼内炎患者5例5眼，低浓度万古霉素组3例3眼，术后感染性眼内炎发生率为0.022 9%，细菌培养结果为1例铜绿假单胞菌、2例表皮葡萄球菌；头孢呋辛组2例2眼，术后感染性眼内炎发生率为0.012 7%，细菌培养结果为真菌、缓症链球菌各1例。χ

分析两组差异无统计学意义，进行非劣效检验，两组术后感染性眼内炎发病率差异有统计学意义(

0.025)。头孢呋辛组与低浓度万古霉素组出现术后眼内炎患者临床表现无明显差异。术后眼内炎患者采用的治疗方案包括:前房冲洗+注药、玻璃体腔注药、玻璃体切割术、全身输注抗生素、局部激素/抗生素治疗。治疗后，低浓度万古霉素组视力均有提高，头孢呋辛组视力1例视力无提高，1例视力降低。两组患者均未行眼球摘除。

结论

白内障术毕前房注射低浓度万古霉素预防术后感染性眼内炎临床效果不劣于头孢呋辛。

Abstract

Objective

To evaluate the clinical effect of low-concentration vancomycin injection in the anterior chamber for prevention of infectious endophthalmitis in patients after cataract surgery.

Methods

We retrospectively collected the clinical data from 28 845 patients undergoing cataract surgery in our hospital between January 2016 and December 2019

who received injection of low-concentration vancomycin (0.01 mg/mL

0.1 mL; 13 068 eyes in 7 318 cases) or cefuroxime (10 mg/mL

0.1 mL; 15 777 eyes in 8 935 cases) in the anterior chamber at the end of surgery for prevention of endophthalmitis. The patients' postoperative visual acuity

intraocular pressure

cornea

anterior chamber and intraocular lens under slit lamp

vitreous opacity with B-mode ultrasound

and laboratory culture results were analyzed to identify the patients with infectious endophthalmitis

and the treatments and outcomes of the patients were analyzed.

Results

The incidence of postoperative infectious endophthalmitis was 0.022 9% (3 eyes in 3 cases) in low-concentration vancomycin group and 0.012 7% (2 eyes in 2 cases) in cefuroxime group

showing a significant difference between the 2 groups (

0.025). The results of bacterial culture identified cases of infections with

Pseudomonas aeruginosa

(1 case) and

Staphylococcus epidermidis

(2 cases) in low-concentration vancomycin group and infections with fungus (1 case) and

Streptococcus mitis

(1 case) in cefuroxime group. The clinical manifestations of infectious endophthalmitis in the identified cases did not differ significantly between the cefuroxime group and vancomycin group. The treatments of postoperative endophthalmitis included anterior chamber washing and drug injection

intravitreal drug injection

vitrectomy

systemic antibiotic infusion

and local hormone/antibiotic treatment. After the treatments

the visual acuity was improved in all cases in vancomycin group

but remained unchanged in one case and deteriorated in another in cefuroxime group. None of the patients required enucleation.

Conclusion

The clinical effect of low-concentration vancomycin injection in the anterior chamber is not inferior to that of cefuroxime injection for prevention of postoperative infectious endophthalmitis after cataract surgery.

关键词

Keywords

references

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