미세절개유리체절제술을 통한 특발 망막앞막 수술 후 발병한 급성 안내염의 발생률 및 임상 경과
Incidence and Clinical Course of Acute Endophthalmitis after Idiopathic Epiretinal Membrane Surgery with Microincision Vitrectomy
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 미세절개유리체절제술로 특발 망막앞막 수술 후 발생한 급성 안내염의 발생률과 임상 경과를 알아보고자 하였다. 대상과 방법: 2011년부터 2021년까지 미세절개유리체절제술로 특발 망막앞막 수술 후 급성 안내염이 발병한 증례들의 의무기록을 분석하였다. 안내염의 발생률, 배양 양성 비율 및 균주, 최종 시력에 대해 조사 후 불량한 시력 예후에 영향을 주는 인자들을 조사하였다. 결과: 총 12,921안에서 미세절개유리체절제술 후 20안(0.15%)에서 급성 안내염이 발생하였다. 그중 3,180안의 특발 망막앞막 증례들에서 14안의 안내염이 발생하여 발생률과 발생률비는 각각 0.44% 및 7.1이었다(p<0.001, 95% confidence interval [CI]=2.6-22.7). 14안모두 특발 망막앞막 수술 시 하나 이상의 공막창을 봉합하지 않았다. 안내염 진단 후 13안은 응급 유리체절제술 후 유리체내 항생제주사를 시행하였고 1안은 유리체내 항생제 주사만으로 치료되었다. 배양 결과 4안(28.6%)에서 모두 표피포도구균이 배양되었고 3안은 메티실린 내성이었다. 최종 시력은 모든 증례들에서 첫 수술 전 시력보다 호전되지 않았고, 그 평균은 20/42에서 20/259로 감소하였다(p<0.001). 법적 실명에 해당하는 20/200 이하의 최종 시력은 6안(42.9%)으로 안내염의 황반 침범은 실명 위험이 높은 단일 소견이었다(p=0.020, odds ratio=35.0, 95% CI=1.7-703.0). 결론: 미세절개유리체절제술을 통한 특발 망막앞막 수술 후 급성 안내염은 다른 망막질환의 수술 후 급성 안내염보다 높은 빈도로발생한다. 해당 안내염이 발병하면 약 40%에서 법적 실명을 할 수 있고 안내염의 황반 침범 시 그 위험이 증가한다.
Abstract
Purpose: To investigate the incidence and clinical course of acute endophthalmitis after idiopathic epiretinal membrane (iERM) surgery employing microincision vitrectomy (MIVS). Methods: We retrospectively reviewed the medical records of eyes with acute endophthalmitis developing after iERM surgery via 23- or 25-gauge MIVS from 2011 to 2021. The incidence, culture-positive rate (and responsible bacteria), final visual acuity (VA), and factors affecting poor visual outcomes were assessed. Results: Acute endophthalmitis developed in 20 of the 12,921 eyes (0.15%) after MIVS. Of these, 14 of 3,180 eyes treated via iERM (0.44%, one per 227 procedures) developed endophthalmitis; the incidence ratio (iERM versus non-iERM) was 7.1 (p < 0.001, 95% confidence interval [CI] = 2.6-22.7). At least one sclerotomy remained unsutured in all eyes after iERM surgery. Thirteen eyes (92.9%) were given intravitreal antibiotic injections after emergency vitrectomy, and one eye was treated with intravitreal antibiotic injection alone. Staphylococcus epidermidis was cultured from four eyes (28.6%); three strains were methicillin- resistant. All final VAs were not better than the initial VAs; the average VA decreased from 20/42 to 20/259 (p < 0.001). Six eyes (42.9%) attained legal blindness status (final VA < 20/200); Macular invasion was a unique risk factor for such blindness (p = 0.020, odds ratio = 35.0, 95% CI = 1.7-703.0). Conclusions: Acute endophthalmitis developing after iERM surgery with MIVS was more common than such endophthalmitis after other retinal surgery. Approximately 40% of the former patients became legally blind, and the risk was higher in eyes with macular involvement of endophthalmitis.
참고문헌 (28)
- 김종민, "Epiretinal Membrane: Prevalence and Risk Factors from the Korea National Health and Nutrition Examination Survey, 2008 through 2012", Korean Journal of Ophthalmology, 31(6), pp.514~523 (2017), 대한안과학회
- Mitchell P, "Prevalence and associations of epiretinal membranes. The blue mountains eye study", Ophthalmology, 104, pp.1033~1040 (1997)
- Kauffmann Y, "Preoperative Prognostic factors and predictive score in patients operated on for combined cataract and idiopathic epiretinal membrane", Am J Ophthalmol, 160, pp.185~192 (2015)
- Lee JW, "Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling : a comparative study", Jpn J Ophthalmol, 54, pp.129~134 (2010)
- Rizzo S, "25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery : a comparative pilot study", Graefes Arch Clin Exp Ophthalmol, 244, pp.472~479 (2006)
- 김주연, "Trends of Pars Plana Vitrectomy Rates in South Korea: A Nationwide Cohort Study", Korean Journal of Ophthalmology, 31(5), pp.446~451 (2017), 대한안과학회
- Das T, "Current management strategies of acute post-operative endophthalmitis", Semin Ophthalmol, 18, pp.109~115 (2003)
- Baudin F, "Epidemiology of acute endophthalmitis after intraocular procedures : a national database study", Ophthalmol Retina, 6, pp.442~449 (2022)
- Park JC, "A prospective and nationwide study investigating endophthalmitis following pars plana vitrectomy : incidence and risk factors", Br J Ophthalmol, 98, pp.529~533 (2014)
- Scott IU, "Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy : incidence and outcomes", Retina, 28, pp.138~142 (2008)
- Chen G, "Incidence of endophthalmitis after vitrectomy : a systematic review and meta-analysis", Retina, 39, pp.844~852 (2019)
- Ben Ghezala I, "Incidence of acute postoperative endophthalmitis following macular surgery in France between 2006 and 2016", Acta Ophthalmol, 98, pp.e333~8 (2020)
- Lee JE, "Internal Limiting Membrane Surgery" (2021), Springer
- Terry RL, "CCLRU standards for success of daily and extended wear contact lenses", Optom Vis Sci, 70, pp.234~243 (1993)
- Jabs DA, "Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop", Am J Ophthalmol, 140, pp.509~516 (2005)
- Nussenblatt RB, "Standardization of vitreal inflammatory activity in intermediate and posterior uveitis", Ophthalmology, 92, pp.467~471 (1985)
- Vashist P, "Definition of blindness under national programme for control of blindness : do we need to revise it?", Indian J Ophthalmol, 65, pp.92~96 (2017)
- Scott IU, "Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy", Graefes Arch Clin Exp Ophthalmol, 249, pp.377~380 (2011)
- Kaiser RS, "The Microsurgical safety task force : evolving guidelines for minimizing the risk of endophthalmitis associated with microincisional vitrectomy surgery", Retina, 30, pp.692~699 (2010)
- Shimada H, "Incidence of endophthalmitis after 20-and 25-gauge vitrectomy causes and prevention", Ophthalmology, 115, pp.2215~2220 (2008)
- Inoue Y, "Preoperative disinfection of the conjunctival sac with antibiotics and iodine compounds : a prospective randomized multicenter study", Jpn J Ophthalmol, 52, pp.151~161 (2008)
- Machida Y, "Microincision vitrectomy surgery : experimental visualization and quantification of vitreous contamination", BMC Ophthalmol, 20, pp.441~ (2020)
- Hatano H, "Experimental Pseudomonas endophthalmitis in rabbits. Intracameral inoculation of two pseudomonal strains", Nippon Ganka Gakkai Zasshi, 86, pp.839~845 (1982)
- Chung JL, "Antibiotic susceptibility of conjunctival bacterial isolates from refractive surgery patients", Ophthalmology, 116, pp.1067~1074 (2009)
- Gentile RC, "Microbiological spectrum and antibiotic sensitivity in endophthalmitis : a 25-year review", Ophthalmology, 121, pp.1634~1642 (2014)
- Sakamoto T, "Increased incidence of endophthalmitis after vitrectomy relative to face mask wearing during COVID-19 pandemic", Br J Ophthalmol (2022)[DOI]
- 이유현, "유리체절제술 후 발생한 안내염의 시력 결과에 대한 내경계막제거술의 영향", 대한안과학회지, 56(2), pp.213~218 (2015), 대한안과학회
- Doft BM, "Retinal detachment in the endophthalmitis vitrectomy study", Arch Ophthalmol, 118, pp.1661~1665 (2000)