백내장 수술 후 발생한 안내염으로 의뢰된 113 사례 분석 및 시력예후와 관련된 인자
Analysis of Referred 113 Patients with Endophthalmitis after Cataract Surgery and Associated Prognostic Factors
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목적: 백내장 수술 후 발생한 감염성 안내염으로 본원에 의뢰되어 치료 받은 환자들을 분석하여 최종 시력과 연관된 인자들을 분석하고자 하였다. 대상과 방법: 2008년부터 2013년까지 백내장 수술 후 발생한 안내염으로 본원에 의뢰된 환자 113명의 의무기록을 후향적으로 조사하였다. 초진시력, 술 후 안내염 발생 시기, 전방축농 유무, 의뢰되어 시행한 치료의 종류, 균 동정 유무 및 종류 등이 최종시력에 미치는 영향을 조사하였다. 결과: 환자 총 113명 중 초진시력이 안전수동 이하인 환자는 75명(66.3%)이었으며, 치료 후 최종시력이 0.5 이상 회복된 환자는 73명(64.6%)이었다. 초진시력이 안전수동 이상인 경우에 시력예후가 더 좋았으며(p=0.001), 그람 음성균에 의한 감염인 경우(p=0.007) 또는 백내장 수술 후 2일 이내에 발생한 안내염인 경우(p=0.043) 최종시력이 유의하게 나빴다. 초진시력이 안전수동 이상인 환자에서 초기 치료로 유리체절제술과 안구 내 항생제주입술은 최종시력에 유의한 차이가 없었다. 결론: 초진시력, 동정된 균의 종류와 백내장 수술 후 안내염 발생까지의 기간이 치료 후 좋은 시력예후와 연관이 있었다. 조기 유리체절제술과 안구 내 항생제주입술의 치료 효과는 분명치 않았으나, 향후 추가적인 연구가 필요할 것으로 보인다.
Abstract
Purpose: To evaluate factors affecting final visual acuity by analyzing patients referred with infectious endophthalmitis after cataract surgery. Methods: A retrospective investigation of clinical notes of 113 patients referred with endophthalmitis following cataract surgery was conducted from January 2008 to December 2013. To evaluate factors affecting final visual acuity, initial visual acuity, onset of endophthalmitis after the cataract surgery, types of treatment, presence of hypopyon and culture results were investigated. Results: Of the 113 patients, visual acuities at presentation were hand motions or less in 75 patients (66.3%) and final visual acuities after treatments were 0.5 or better in 73 patients (64.6%). Cases with initial visual acuity of hand motions or better achieved favorable outcomes whereas cases with gram-negative infection or endophthalmitis occurring within 2 days postoperatively showed poor prognosis. Statistically, vitrectomy versus intraocular antibiotic injection as primary means of treatment showed no differences in final visual acuity in patients with initial visual acuity of hand motion or better. Conclusions: Visual acuities at presentation, type of cultured organism and onset of endophthalmitis after cataract surgery are significantly related to visual prognosis. Advantages of initial vitrectomy versus intraocular antibiotic injections were unclear and further investigations are necessary to clarify these issues.
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