Reduktion der postoperativen Endophthalmitisrate durch intrakamerale Cerfuroximgabe: Ergebnisse aus 5 Jahren Erfahrungen an der Universitäts-Augenklinik Tübingen

Zusammenfassung

Hintergrund: Die Kataraktoperation ist die am häufigsten durchgeführte Operation in den Industrieländern. Allein in Deutschland werden jährlich über 600 000 Eingriffe durchgeführt. Die akute postoperative Endophthalmitis ist die schwerwiegendste und am meisten gefürchtete Komplikation bei Kataraktoperationen. Verschiedene operative und nicht operative Maßnahmen wurden vorgeschlagen, um diese ernsthafte Komplikation zu verhindern. Die Studie der European Society of Cataract & Refractive Surgeons (ESCRS) war die erste prospektive, randomisierte und partiell placebokontrollierte Studie, welche die Effektivität der intrakameralen Cefuroximgabe als Endophthalmitisprophylaxe zeigen konnte. Das Ziel dieser retrospektiven Studie war es, eine mögliche Reduktion der postoperativen Endophthalmitisrate durch intrakamerale Cefuroximgabe an der Universitäts-Augenklinik Tübingen zu zeigen. Patienten und Methoden: Im Zeitraum zwischen Januar 2002 und August 2013 wurden 2 Zeitintervalle auf Basis der eingeführten intrakameralen Cefuroximgabe nach der Kataraktoperation bestimmt. Zwischen Januar 2002 und Mai 2009 erhielten Patienten am Ende der Kataraktoperation eine subkonjunktivale Gabe von 50 mg Mezlocillin und anschließend antibiotische Augentropfen (Gentamicin) ohne intrakamerale Injektion. Zwischen Juni 2009 und August 2013 erhielten Patienten eine intrakamerale Injektion mit 1 mg Cefuroxim in 0,1 ml, antibiotische Augentropfen (Moxifloxacin) wurden zusätzlich verwendet. Es wurden die Raten der postoperativen infektiösen Endophthalmitis in diesen beiden Zeitintervallen berechnet. Ergebnisse: Es traten 31 Fälle von postoperativer infektiöser Endophthalmitis bei 31 386 Kataraktoperationen auf. Die Gesamtinzidenz betrug 0,99 pro 1000 Patienten. Die Inzidenz im 1. Zeitintervall ohne intrakamerale Cefuroximgabe betrug 1,38 (95 %-Konfidenzintervall [KI]: 1,03–1,72) pro 1000 Patienten und im 2. Intervall 0,44 (95 %-KI: 0,34–0,54) pro 1000 Patienten (p < 0,001). Schlussfolgerung: Die intrakamerale Cefuroximgabe nach Kataraktoperation reduziert die postoperative infektiöse Endophthalmitisrate signifikant.

Abstract

Background: Cataract surgery is the most commonly performed surgical procedure in developed countries. The annual number of cataract surgeries in Germany is about 600,000. Acute postoperative endophthalmitis is a very severe and the most dreaded complication of cataract surgery. Various operative and non-operative measures have been suggested to prevent this serious complication. The European Society of Cataract & Refractive Surgeons (ESCRS) study of intracameral cefuroxime was the first prospective, randomised and partially placebo-controlled clinical trial showing the efficacy of antibiotic prophylaxis to prevent endophthalmitis in 2007. The aim of this retrospective study is to investigate a possible reduction of intracameral cefuroxime to prevent postoperative endophthalmitis at the University Eye Hospital Tübingen. Patients and Methods: During the period from January 2002 to August 2013, 2 time periods were determined based on the adoption of intracameral cefuroxime injections after cataract surgery. From January 2002 to May 2009 patients received at the end of cataract surgery a subconjunctival administration of 50 mg of mezlocillin and postoperative antibiotic eye drops (gentamicin) without intracameral injection. From June 2009 to August 2013, patients received an intracameral injection of cefuroxime while antibiotic drops (moxifloxacin) were used too. The rates of postoperative infectious endophthalmitis during these 2 periods were calculated. Results: 31 cases of endophthalmitis occurred in 31,386 cataract surgeries. The overall cumulative incidence was 0.99 per 1000 patients. The incidence in the first period without intracameral cefuroxime injection was 1.38 (95 % confidence interval [CI]: 1.03–1.72) per 1000 patients and in the second period 0.44 (95 % CI: 0.34–0.54) per 1000 patients (p < 0.001). Conclusion: Intracameral injection of cefuroxime reduces the rate of postoperative infectious endophthalmitis in cataract surgery significantly.

Schlüsselwörter

intraokulare Entzündung - Katarakt - intrakameral Cefuroxim - Phakoemulsifikation - Endophthalmitis

Key words

intraocular inflammation - cataract - intracameral cefuroxime - phacoemulsification - endophthalmitis

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