眼内异物相关性眼内炎发生的危险因素和视力预后分析

doi:10.3760/cma.j.cn115909-20200518-00213

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摘要目的：探讨眼内异物（IOFB）相关性眼内炎发生的危险因素和视力愈后的影响因素。方法：回顾性研究。收集温州医科大学附属第二医院眼科在2009年1月至2019年10月内收治的IOFB患者，筛选 IOFB相关性眼内炎病例，分析患者的病史资料及眼内异物的材料、大小、位置、损伤情况等因素。并对眼科常规检查及眼内取材的培养鉴定结果进行分析。数据行卡方检验和多因素Logistic回归分析。结果：共纳入IOFB病例338例（339眼），其中IOFB相关性眼内炎40例（40眼），发生率为11.8%， IOFB相关性眼内炎患者年龄（34.0±22.7）岁，男29例（29 眼），女11例（11眼），约62.5%患者年龄集中在21～45岁。外伤发生在工厂23例，家中11例，其他6例（15.0%）。创口大于3 mm者共25例。异物位于前房7例，位于玻璃体腔33例。眼内异物的性质金属类25例，非金属类15例（其中植物性4例）。异物大小超过5 mm的14例，在3～5 mm间17例，小于3 mm 9例。32例眼内取样进行微生物培养， 12例结果为阳性，其中表皮葡萄球菌3例，枯草芽孢杆菌3例，绿脓杆菌2例，其他菌4例，20例结果为阴性。统计分析发现异物材料性质和创口直径不是眼内炎发生的相关危险因素（χ2 =0.57，P=0.45； χ2 =4.73，P=0.094），而异物直径、I期修复的时间与眼内异物被取出时间是其危险因素（χ2 =10.83， P=0.001；χ2 =5.80，P=0.016）。36例（90%）IOFB相关性眼内炎患者视力在0.05以下，19例（47.5%）在光感或以下；在眼球修补和异物取出术后2周，19例（47.5%）在光感及以下，12例（30.0%）为无光感眼。异物位置在后节、创口大于3 mm和异物大于3 mm是导致IOFB相关性眼内炎患者更差视力愈后的危险因素（χ2 =3.23，P=0.023；χ2 =3.72，P=0.037；χ2 =4.14，P=0.041），而一期眼球修补时间和异物取出时间与视力预后无明显相关性（χ2 =0.63，OR=0.97，P=0.92）。结论：IOFB相关性眼内炎往往发生于男性青壮年工人，且严重损伤视功能；异物位置、异物大小和是否一期24 h内修补并取出异物是其重要的危险因素，而视力预后与异物位置、异物大小和创口长度密切相关。

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关键词 ： , 眼内异物, 眼内炎, 危险因素, 临床分析

Abstract： Objective: To investigate the risk factors of intraocular foreign-body (IOFB) related endophthalmitis and the factors that influence visual outcomes. Methods: This was a retrospective study. From January 2009 to October 2019, cases of IOFB injury were included from the Department of Ophthalmology in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, and the cases of IOFB-related endophthalmitis were selected. The medical history, cause and time of injury, clinical manifestations and the best corrected visual acuity were recorded. The foreign-body related information such as materials, size, location and surgical information were recorded and routine ophthalmologic examinations, intraocular sample cultures and identification were carried out. All results were documented and analyzed by Chi-square test and multivariate logistic regression. Results: Forty endophthalmitis cases were diagnosed in 338 patients with IOFB injury, indicating an incidence rate of 11.8%. Twenty-nine males and 11 females were included, with an average age of 34.0±22.7 years, and approximately 62.5% of patients were between 21 and 45 years old. Twenty-three cases of trauma occurred in factories and 11 cases at home. There were 25 cases of metallic foreign bodies, and 15 nonmetallic cases (4 plant-based cases). Diameter of IOFB >5 mm in 14 cases, 3-5 mm in 17 cases, <3 mm in 9 cases. Positive microbial culture was found in 12 intraocular samples, including staphylococcus epidermidis in 3 cases, bacillus subtilis in 3 cases, and pseudomonas aeruginosa in 2 cases, while there was negative culture in 20 cases, and 8 cases failed. Statistical analysis demonstrated that the character of foreign body material and wound length were not correlated risk factors for the development of endophthalmitis (χ2 =0.57, P=0.45; χ2 =4.73, P=0.094), while the foreign body diameter, the timing of the primary repair and IOFB removal within 24 hours were demonstrated as protective factors (χ2 =10.83, P=0.001; χ2 =5.80, P=0.016). Ninty percent of patients with IOFB-related endophthalmitis had a final vision lower than 0.05, nearly 50% of eyes had light perception or below after injury, 47.5% of eyes achieved a final visual outcome with light perception or below after treatment, and 12 eyes were blinded with non-light perception. Statistical analysis with a Chi-square test indicated that the location and size of the foreign body and the wound length were prognostic factors for visual outcomes (χ2 =3.23, P=0.023; χ2 =4.14, P=0.041; χ2 =3.72, P=0.037), while the timing of the primary repair and IOFB removal within 24 hours had no obvious correlation with visual prognosis (χ2 =0.63, OR=0.97, P=0.92). Conclusions: IOFB-related endophthalmitis frequently occurs in young and middleaged male workers and results in severe visual functional impairment. The location and size of the foreign body, the timing of the primary repair and IOFB removal within 24 hours were independent risk factors for the occurrence of endophthalmitis, while visual prognosis was closely related to the location and size of the foreign body and wound length.

Key words： intraocular foreign body endophthalmitis risk factors clinical analysis

收稿日期: 2020-05-18

PACS:

基金资助: 温州市基础性科研计划项目（Y20190167）；温州医科大学高等教育教学改革项目（YBJG2019030）

通讯作者: 郑海华（ORCID：0000-0002-2571-6844），Email：eyezhh@126.com

引用本文:

甘一峰1 曹佳蓉2 宋广伟2 郑海华2 董志章2. 眼内异物相关性眼内炎发生的危险因素和视力预后分析[J]. 中华眼视光学与视觉科学杂志, 2021, 23(2): 109-115. Yifeng Gan1,Jiarong Cao2,Guangwei Song2,Haihua Zheng2,Zhizhang Dong2. Analysis of the Visual Outcomes and Clinical Risk Factors for the Occurence of Intraocular Foreign-Body Related Endophthalmitis. Chinese Journal of Optometry Ophthalmology and Visual science, 2021, 23(2): 109-115. DOI: 10.3760/cma.j.cn115909-20200518-00213

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20200518-00213 或 https://www.cjoovs.com/CN/Y2021/V23/I2/109

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