白内障手術後眼内炎の発症頻度と予防

Incidence and prevention of endophthalmitis following cataract surgery

　過去5年間に白内障手術後眼内炎を14例経験した。その起因菌は腸球菌などのグラム陽性球菌が多かった。眼内炎は腸球菌によるものなど早期発症で急激に進行するものほど，視力予後が不良であった。術後眼内炎は完全な消毒や点眼，内服，点滴などの抗生物質投与のみでは完全に予防できず，抗生物質を白内障手術時の灌流液内に注入する必要があると考えられた。当院での白内障手術後眼内炎の発症率は0.08％，小切開角膜切開無縫合手術では0.05％であった。灌流液内にイミペネムを注入後は，術後眼内炎の発症はない（0／2,160例）。

We observed 14 cases of endophthalmitis following cataract surgery during the past 5 years. Gram-positive coccus, including Enterococcus faecalis, was the most frequent causative organism. Endophthalmitis due to Enterococcus faecalis tended to develop soon after surgery and to run a fulminant course resulting in poor visual outcome. An perfect prevention of postoperative infection is impossible with sterilazation, topical or systemic antibiotics, it is necessary to add antibiotics to the irrigating solution. Our incidence of infection was 0.08% after cataract surgery in general and was 0.05% after small- and self-sealing incision procedure. There has been no instance of endophthalmitis in the consecutive series of 2,160 cases of cataract surgery after we added imipenem to the irrigating solution.