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201605前房注射头孢呋辛可降低

题:前房内注射头孢呋辛阻止伴或不伴围手术期囊膜破裂的白内障术后眼内炎的有效性和安全性评价(英文题:EffectivenessandSafetyofanIntracameralInjectionofCefuroximeforthePreventionofEndophthalmitisAfterCataractSurgeryWithorWithoutPerioperativeCapsularRupture;作者:VincentDaien等;作者单位:法国蒙彼利埃GuideChauliac医院眼科)白内障手术是有效的和相对安全的。术后最严重的并发症有视网膜脱离、黄斑囊样水肿以及眼内炎。术后眼内炎(postoperativeendophthalmitis,POE)可以导致严重的视力损害。POE的高危因素包括高龄(≥85岁)、男性、围手术期并发症、透明角膜切口等。POE的发生率较之前有增加,可能由于角膜透明切口的转变。年开始,瑞典眼科医生常规前房注射头孢呋辛治疗POE,并取得良好的结果。有研究表明,前房注射头孢呋辛是有效的,可以将POE的发生率降低5倍。目前,并没有关于头孢呋辛预防POE的使用标准。一些医生不使用头孢呋辛预防POE,主要是担心其作为非商业制备的抗菌制剂所带来的风险。白内障手术围手术期的主要并发症是晶状体囊膜的破裂,可以导致视力下降,增加黄斑囊样水肿、POE的发生率。年,白内障手术中前房注射头孢呋辛已经被法国当局批准。我们现在是评估在常规临床应用中头孢呋辛对POE的影响。因此,我们的研究目的是评估从年1月至年10月在法国POE发病率的转变,及其在白内障手术中前房注射头孢呋辛的关系,以及其他危险因素。另外,对前房注射头孢呋辛视网膜的安全性的评估。本研究数据来源于年1月至年10月间,在法国行白内障手术的病人。病人接受白内障超声乳化吸除和人工晶状体植入术。玻璃体切除术治疗后囊膜破裂被记录,黄斑囊样水肿作为评估视网膜安全性的指标。结果显示:位病人(眼)行白内障手术。术后6周位病人发生POE。自年至年随着头孢呋辛预防注射的使用增加,POE的发生率降低。多因素回归分析,头孢呋辛的使用使POE发生率降低(比值比,0.61[95%CI,0.56-0.68])。注射头孢呋辛,黄斑囊样水肿的发生率并没有增加。对于围手术期伴囊膜破裂的病人,接受头孢呋辛治疗者较未接受治疗者,POE发生率明显降低(0.37%vs0.51%,[P=0.]),但黄斑囊样水肿的发生率并无差异(5.6%vs7.3%,[P=.12])。因此本研究结果提示,白内障手术前房注射头孢呋辛可以降低POE的发生率,并且对于伴或不伴囊膜破裂的病人来说都是安全的。(于新新报道)IMPORTANCE:Postoperativeendophthalmitis(POE)oftenresultsinseverevisualimpairment.Inclinicalstudies,anintracameralcefuroximeinjectionattheendofsurgerywasfoundtobeeffectiveatreducingtheincidenceofPOE.TwoimportantissuesaretheretinalsafetyofcefuroximeanditsuseforpatientswithperioperativecapsularrupturewheretheriskofPOEisdramaticallyincreased.OBJECTIVE:ToassesstheeffectivenessandretinalsafetyofanintracameralinjectionofcefuroximesodiumforthepreventionofPOEanditspossibleuseincasesofaperioperativecapsularruptureofthelens.DESIGN,SETTING,ANDPARTICIPANTS:Population-basedcohortstudyofpatients40yearsofageorolderwhounderwentcataractsurgeryat1ofFrenchhealthcarefacilities,publicorprivate,andwhosemedicalrecordswereobtainedfromthenationaladministrativedatabase.DataanalyseswereperformedbetweenMarchandNovember.MAINOUTCOMESANDMEASURES:TheeffectivenessandsafetyoftheprophylacticinjectionofcefuroximeasmeasuredbytheincidenceofPOEandcystoidmacularedema.RESULTS:FromJanuarytoOctober,atotalof3??eyesof2??patients40yearsofageorolder(58.9%werewomen,andthemean[SD]agewas73.9[9.5]years)underwentcataractsurgery;patients(0.08%)developedPOEduringthe6weeksaftercataractsurgery.TheincidenceofPOEaftercataractsurgerydecreasedoverthecourseofthestudy(0.11%,0.09%,0.08%,0.06%,and0.05%in,,,,and,respectively[P?=?.fortrend])astheuseofcefuroximeprophylacticinjectionsincreased(11.1%,14.4%,32.8%,64.8%,and79.1%in,,,,and,respectively[P?=?.fortrend]).Aftermultivariateadjustment,theriskofPOEwasreducedwiththeuseofcefuroxime(oddsratio,0.61[95%CI,0.56-0.68]).Theretinalsafetyofaninjectionofcefuroxime,whichwasassessedbymultiadjustedoddsofretinalcystoidmacularedema,wasnotincreasedforpatientsreceivingcefuroximeinjections(oddsratio,0.86[95%CI,0.71-1.05]).Forpatientswithaperioperativecapsularruptureofthelens(themajorriskfactorforPOE),theincidenceofPOEwaslowerforthosewhoreceivedaninjectionofcefuroximethanforthosewhodidnot(0.37%vs0.51%,respectively[P?=?.]),whereasanincreasedriskofcystoidmacularedemawasnotidentifiedforthosewhoreceivedordidnotreceiveaninjectionofcefuroxime(5.6%vs7.3%,respectively[P?=?.12]).CONCLUSIONSANDRELEVANCE:Thesedatasuggestthat,inroutinepractice,theintracameralinjectionofcefuroximeattheconclusionofcataractsurgeryisassociatedwithalowerriskofPOEandissafeforpatientswithorwithoutaperioperativecapsularrupture.WhilethesedatamightbeusedtosupporttheconsiderationofitsroutineusetopreventPOE,intheabsenceofarandomizedclinicaltrial,theycannotproveadirectcause-and-effectrelationshipbetweentheinjectionofcefuroximeandPOE.需要原文请留邮箱温医眼视光临床科研中心







































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