关键词: 万古霉素, 白内障/外科学, 非感染性炎性反应

Abstract:

Objective To retrospectively analyze the characteristics of non-infectious inflammation associated with low concentration vancomycin injected into anterior chamber at the end of cataract surgery. Design Retrospective case series. Participants From January 2014 to November 2017, 24 916 patients underwent cataract surgery in our hospital. All patients were injected with vancomycin 0.1ml (0.01mg/ml) into anterior chamber at the end of operation. Methods We retrospectively analyzed the patients with low concentration vancomycin (0.01 mg/ml, 0.1 ml) injected into anterior chamber at the end of cataract surgery in our hospital. After operation, the visual acuity improved satisfactorily. Returned patients with visual impairment underwent slit lamp examination, B-mode ultrasonography, macular OCT examination, FFA examination and pathogenic microorganism examination of aqueous humor. After excluding patients with infectious endophthalmitis, the remaining patients with significant inflammation underwent, examination including interleukin-6 (IL-6) in aqueous humor, vascular endothelial growth factor (VEGF), transforming factor (TGF-β1), vascular cell adhesion factor (VCAM), 21 types of common inflammatory microbial nucleic acids, broad-spectrum bacterial nucleic acids and broad-spectrum fungal nucleic acids. The cornea, anterior chamber and intraocular lens were examined under slit lamp. B-mode ultrasonography was used to detect vitreous opacity. The change of treatment plan and prognosis of these patients were recorded. Main Outcome Measures Visual acuity, intraocular pressure, cornea, cornea  status under slit lamp, anterior chamber and intraocular lens status, vitreous opacity under B-mode ultrasound, inflammatory factors in aqueous humor, 21 kinds of common inflammatory microbial nucleic acids, broad-spectrum bacterial nucleic acids and broad-spectrum fungal nucleic acids in eyes. Treatment plan and prognosis of patients. Results After excluding infective endophthalmitis, 21 cases (25 eyes), including 17 unilateral cases and 4 bilateral cases were found with non-infections endophthalmitis. The average onset time of intraocular inflammation was 22.26±12.58 days after cataract surgery. The inflammatory factors detected in aqueous humor including VEGF (96.95±58.49) pg/ml (reference interval 0-40.0), TGF-β (175.05±33.55) pg/ml (reference interval < 1.0), IL-6 (29123.83±16066.97)pg/ml (reference interval 1.0-50.0), IL-10 (5.85±1.15)pg/ml (reference interval 0-50.0), VCAM (14650±10144.62)pg/ml (reference interval 200-1000). ) None of the 21 pathogenic microorganisms were detected, and no fungi and bacterial growth were detected by culture and microscopy. Under slit lamp, corneal edema was mild, anterior chamber plankton cells and Tyn sign were positive, and intraocular lens was transparent in situ. Eye ultrasound showed vitreous opacity. Vancomycin treatment led to no improvement or even aggravated. Vancomycin was discontinued and steroidal therapy was used instead, and the condition was obviously relieved. Conclusion Inflammatory factors in aqueous humor of these patients are elevated, and pathogenic microorganisms are not detected by multiple examinations, so non-infectious inflammation is considered. Because the onset time is the same as that of type III hypersensitivity reaction after systemic use of vancomycin, and vancomycin aggravates the condition and discontinuation of vancomycin relieves symptoms, so it is considered that the disease is related to the use of vancomycin. It is suggested that the pros and cons of vancomycin in preventing endophthalmitis should be weighed, follow-up should be emphasized and steroid therapy should be given to suspected cases. (Ophthalmol CHN, 2019, 28: 90-95)

Key words: vancomycin, cataract/surgery, non-infectious inflammatory response