青光眼滤过手术后迟发性感染的危险因素

Arch Ophthalmol. 2001;119:1001-1008

方法：病例对照研究，比较了10个医疗中心27个眼外科医生的131例迟发性感染病例及其500例手术日期及术者匹配的对照病例。诊断迟发性感染的标准是手术后4周出现严重的前房反应。诊断不需要出现滤泡性混浊和阳性培养结果。通过单变量和多元回归分析来找出危险因素。

结果：多元回归分析模型调整年龄、性别、种族后发现下列危险因素有统计学意义：(1)全层厚度手术相对于谨慎的手术操作（相对危险度RR13.1，95%的可信限CI2.12-80.9），（2）没有同时做白内障手术的滤过手术（RR, 2.25; 95% CI, 1.24-4.08），（3）使用丝裂霉素（RR, 2.48; 95% CI, 1.06-5.83），（4）手术后间断使用抗生素（RR, 2.10; 95% CI, 1.09-4.02)，（5）手术后持续使用抗生素（RR, 5.94; 95% CI, 2.09-16.9）。

Risk Factors for Late-Onset Infection Following Glaucoma Filtration Surgery

Henry D. Jampel, MD, MHS; Harry A. Quigley, MD; Lisa A. Kerrigan-Baumrind, MS; B. Michele Melia, ScM; David Friedman, MD, MPH; Yolanda Barron, MS; for the Glaucoma Surgical Outcomes Study Group

Objective To determine the risk factors for late-onset infection following glaucoma filtration surgery.

Methods We performed a case-control study comparing 131 cases of late-onset infection collected from 27 surgeons at 10 centers with 500 controls matched for date of surgery and surgeon. The criterion for the presence of infection was severe anterior chamber reaction occurring later than 4 weeks after surgery. An opaque bleb and positive culture results were not required for diagnosis. Risk factors were identified by univariate and multivariate logistic regression analyses.

Results Some of the risk factors that were statistically significant in the multivariate model after adjusting for age, race, and sex were (1) performance of a full-thickness rather than a guarded procedure (risk ratio [RR], 13.1; 95% confidence interval [CI], 2.12-80.9), (2) filtration surgery performed without concurrent cataract surgery (RR, 2.25; 95% CI, 1.24-4.08), (3) use of mitomycin (RR, 2.48; 95% CI, 1.06-5.83), (4) intermittent use of antibiotics after surgery (RR, 2.10; 95% CI, 1.09-4.02), and (5) continuous use of antibiotics after surgery (RR, 5.94; 95% CI, 2.09-16.9).

Conclusions Eyes undergoing full-thickness procedures or filtration surgery without cataract extraction are at increased risk for late infection. Intraoperative mitomycin and episodic or continuous antibiotic use after the postoperative period are associated with an increased risk of infection.

Arch Ophthalmol. 2001;119:1001-1008