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ENGLISH ABSTRACT
莫西沙星前房注射预防白内障术后细菌性眼内炎的研究进展
严唯佳
周海燕 [综述]
严宏 [综述]
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20210304-00146
Research progress of intracameral moxifloxacin in the prevention of bacterial endophthalmitis after cataract surgery
Yan Weijia
Zhou Haiyan
Yan Hong
Authors Info & Affiliations
Yan Weijia
Yan Weijia is now a doctoral student of Department of Ophthalmology, Heidelberg University Hospital, Heidelberg 69120, Germany
Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China
Zhou Haiyan
Department of Ophthalmology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
Yan Hong
Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China
·
DOI： 10.3760/cma.j.cn115989-20210304-00146
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摘要

白内障术后眼内炎(POE)是一种罕见的威胁视力的并发症，在我国的发病率为0.033%~0.11%。近几年有大量的病例对照研究和回顾性系列病例分析研究指出，白内障术毕前房注射抗生素可有效降低细菌性眼内炎的发生率，其中常用的药物包括头孢呋辛、万古霉素和莫西沙星。由于全球各地POE致病菌种类、抗生素的可获得性、成本效益等因素存在差异，药物的选择也存在很大差异。前房内注射抗生素引起的不良事件屡见发生，包括过量注射头孢呋辛导致的黄斑水肿、视网膜血管渗漏和葡萄膜炎，万古霉素引起出血性闭塞性视网膜血管炎等并发症。莫西沙星作为第4代氟喹诺酮类药物对细菌性眼内炎有明显的预防作用。本文着重归纳了近5年前房注射抗生素预防POE研究结果，就莫西沙星在细菌性眼内炎预防、药物安全性、前房药物持续时间以及成本效益方面进行综述。

前房注射;细菌性眼内炎;白内障术后;莫西沙星;头孢呋辛;万古霉素
ABSTRACT

Postoperative endophthalmitis (POE) is a serious vision-threatening complication of cataract surgery, with an incidence rate of 0.033%-0.11% in China.In recent years, numerous retrospective studies and data analyses have reported that intracameral injection of antibiotics can effectively reduce the incidence of bacterial endophthalmitis, which commonly include cefuroxime, vancomycin and moxifloxacin.Globally, due to factors such as the availability, cost-effectiveness, and types of pathogens of POE, the drug choice varies to a large extent.Adverse events caused by antibiotics in the intracameral injection often occur, including macular edema, retinal vascular leakage, and uveitis caused by overdose of cefuroxime, and complications such as hemorrhagic retinal vasculitis obliterans due to vancomycin.Moxifloxacin, as a fourth-generation fluoroquinolone, has a significant effect on the prevention of bacterial endophthalmitis.Studies in the past five years related to moxifloxacin, and the significant advantages of moxifloxacin in the prevention of bacterial endophthalmitis, drug safety, duration of intracameral drug, and cost-effectiveness were summarized in this article.

Injections, anterior chamber;Endophthalmitis, bacterial;Cataract, postoperative;Moxifloxacin;Cefuroxime;Vancomycin
Yan Hong, Email: mocdef.labiamtohst8212nay
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引用本文

严唯佳,周海燕,严宏. 莫西沙星前房注射预防白内障术后细菌性眼内炎的研究进展[J]. 中华实验眼科杂志,2022,40(05)：461-465.

DOI:10.3760/cma.j.cn115989-20210304-00146

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白内障术后眼内炎(postoperative endophthalmitis，POE)是严重威胁视力的并发症，通常由毒力较强的细菌感染导致 [ 1 ]。据统计，我国大型眼科机构POE的发病率为0.033% [ 2 ]，中小型眼科机构的发病率高达0.11%，发达国家POE的发病率为0.012%~0.053% [ 3 ]。国内外相关研究指出，术前眼睑和结膜囊聚维酮碘消毒、术毕前房内注射抗生素以及术后局部应用抗生素滴眼液这3种措施对预防POE明确有效 [ 4 , 5 ]。其中，前房注射抗生素可以直接、快速地使眼内抗生素达到峰值，抑制术中操作带入的细菌。该方法安全、经济，同时提高了药物的利用率 [ 6 ]。欧洲白内障和屈光外科医师协会于2007年发表的前瞻性随机试验研究结果表明，前房注射抗生素(头孢呋辛1 mg/0.1 ml)可以使POE的发生率降低83% [ 7 ]。在美国白内障和屈光手术协会(ASCRS)调查中，眼科医生在白内障术毕常规前房内注射抗生素的比率从2007年的30%和2014年的50%增加到2021年的66% [ 8 ]。目前，世界范围内常规白内障术毕前房注射抗生素预防术后细菌性眼内炎的比率持续增加，但临床医生对前房注射抗生素预防POE尚未达成共识。因此，亟需更加有说服力的临床病例、前瞻性试验数据等为前房注射抗生素提供更好的指导。有关前房注射头孢呋辛和万古霉素的临床研究较多，近年对前房注射莫西沙星有新的研究成果，本文重点就前房注射抗生素类型、前房注射莫西沙星预防POE的研究进行综述，以期为POE临床治疗方案的选择提供参考。
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