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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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

Received: 18 May 2020

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Fund: Wenzhou Basic Scientific Research Project (Y20190167); Wenzhou Medical University Teaching Reform Project in 2019 (YBJG2019030)

Corresponding Authors: Haihua Zheng, Department of Ophthalmology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China (Email: eyezhh@126.com)

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