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目的探讨眼内炎的手术治疗方法及早期玻璃体内注射抗生素对玻璃体切除术治疗外因性眼内炎疗效的影响。设计回顾性病例对照研究。研究对象北京同仁医院2000年1月至2004年12月收治的外因性眼内炎患者94例(94眼)。方法全部患者均在确诊眼内炎后不同时间行常规三通道玻璃体切除术。其中46眼在发现眼内炎后先行玻璃体内注射抗生素,在注药后3-14天(平均5．6天)行玻璃体切除术(Ⅰ组),其余48眼则直接行玻璃体切除术(Ⅱ组)。随访3-12个月(平均7．5个月), 观察患者的视力等术后情况。主要指标视力。结果 94眼术后视力较术前明显提高(P=0．000),其中Ⅰ组治疗有效率优于Ⅱ组 (P=0．029),进一步分析表明在明确眼内炎后7日内即进行玻璃体切除术者无论其术前是否行玻璃体注药术,治疗的有效率差异元统计学意义(P=0．692),但在7天以上者则两组治疗的有效率差异有统计学意义(P=0．008)。结论尽早行玻璃体切除术是治疗外因性眼内炎的有效方法,对于不能尽早施术者,在手术前及时行玻璃体内注射抗生素能明显提高治疗效果。
Objective To investigate the surgical treatment of endophthalmitis and the effect of early vitreous injection of antibiotics on the efficacy of vitrectomy for exogenous endophthalmitis. Design retrospective case-control study. Participants 94 patients (94 eyes) with exogenous endophthalmitis admitted to Beijing Tongren Hospital from January 2000 to December 2004. Methods All patients underwent routine three-channel vitrectomy at different times after the diagnosis of endophthalmitis. Among 46 eyes, vitreous injection of antibiotics was performed after the endophthalmitis was found. Vitrectomy was performed 3 to 14 days after the injection (average 5.6 days), while the remaining 48 eyes were treated by vitrectomy (Ⅱ group). The patients were followed up for 3-12 months (average 7.5 months), and the postoperative conditions such as visual acuity were observed. The main indicator of visual acuity. Results The postoperative visual acuity of 94 eyes was significantly higher than that before operation (P = 0.000). The effective rate of treatment in group Ⅰ was better than that in group Ⅱ (P = 0.029). Further analysis showed that within the first 7 days after definite endophthalmitis Vitreoretinal surgery regardless of their preoperative vitreous body injection, the effective treatment of the difference was statistically significant (P = 0.692), but in more than 7 days, the effective rate of the two groups were statistically significant (P = 0.008). Conclusion As early as possible, vitrectomy is an effective method to treat exogenous endophthalmitis. The intravitreal injection of antibiotics before operation can significantly improve the therapeutic effect.