白内障患者术前术中细菌培养及药物干预研究

目的：研究年龄相关性白内障患者睑缘(睫毛根部睑板腺开口处)和结膜囊应用不同抗生素滴眼液滴眼及不同结膜囊冲洗液冲洗结膜囊后的灭菌效果。

方法：选取2015-01/11在我院拟行白内障超声乳化手术的年龄相关性白内障患者216例216眼随机分成A(72眼)、B(72眼)、C(72眼)三组,术前分别采用3g/L妥布霉素滴眼液、5g/L左氧氟沙星滴眼液及上述两种滴眼液点眼; 再随机分为莫西沙星组(110眼)和聚维酮碘组(106眼),分别于术野常规消毒后手术正式开始前使用1.6g/L莫西沙星和5g/L聚维酮碘冲洗结膜囊。分别于入院未用药前、手术未消毒前及结膜囊冲洗后采集术眼睑缘和结膜囊标本,术毕采集结膜囊标本并抽取前房水进行常规细菌培养及药敏试验。

结果：白内障患者术前睑缘、结膜囊细菌培养阳性率分别为86.6%、25.0%。A、B、C组患者应用不同抗生素滴眼液点眼前后睑缘细菌培养阳性率分别为86.1%和36.1%、84.7%和31.9%、88.9%和30.6%; 结膜囊细菌培养阳性率分别为25.0%和11.1%、26.4%和11.1%、23.6%和8.3%。采用莫西沙星和聚维酮碘组进行结膜囊冲洗前后睑缘细菌培养的阳性率分别为33.6%和10.9%、32.1%和10.4%; 结膜囊细菌培养的阳性率分别为10.0%和0、10.4%和0。

结论：白内障术前联合使用3g/L妥布霉素和5g/L左氧氟沙星滴眼液点眼清洁睑缘和结膜囊效果更佳,5g/L聚维酮碘和1.6g/L莫西沙星均可作为白内障术前结膜囊冲洗液使用。     

正常眼和白内障手术前后结膜囊细菌菌谱及抗生素应用的对比研究

目的检查正常眼的结膜囊存在的细菌种类,并进行药敏分析,对目前临床常用的抗生素滴眼液药效进行对比。方法207例(207眼)正常眼及200例(200眼)白内障的结膜囊标本进行细菌培养,200例白内障分4组给予林可霉素,妥布霉素,氧氟沙星,左氧氟沙星滴眼后术前及手术后再次培养,并将所有培养为阳性的标本进行药敏分析。结果407眼的结膜囊细菌培养阳性率31.45%,其中70岁以上者阳性率最高为42.05%(37/88)。革兰氏阳性球菌阳性率达到80.47%,革兰氏阴性杆菌为16.40%。4种抗生素结膜囊细菌的清除率分别为70.59%、89.47%、94.74%、100.00%;所有白内障眼术前使用抗生素后细菌阳性率为4.00%,手术后1 d拆开眼垫后细菌培养阳性率为6.00%。结论正常眼的结膜囊可有多种细菌存在,高龄者检出率高。其中以表皮葡萄球菌多见,其次为洛菲不动杆菌和金黄葡萄球菌;目前常用的4种抗生素滴眼液的效果强弱不同,提示在临床进行白内障等内眼手术时应根据结膜囊细菌培养的情况选用敏感抗生素,术后也应进行局部抗生素滴眼液的应用。     

准分子激光原位角膜磨镶术患者术前结膜囊细菌培养的病原学分析

目的了解准分子激光原位角膜磨镶术(laser insitu keratomileusis,LASIK)患者术前结膜囊细菌病原学特征及术前用药效果。方法对135例(270眼)LASIK患者于术前用药前和用药后进行结膜囊细菌培养并行药敏试验。结果270眼用药前结膜囊细菌培养有136眼(占50.37%)培养出细菌,其中表皮葡萄球菌104眼(占76.47%),大肠杆菌18眼(占13.24%);用药后222眼中有2眼(占0.90%)培养出细菌,为微球菌。所培养出的细菌均对妥布霉素、左氧氟沙星敏感。结论LASIK术前有必要局部滴用有效的抗菌素滴眼液清洁结膜囊以预防术后感染。     

准分子激光近视手术前结膜囊细菌培养的病原学分析

目的 观察准分子激光手术患者术前结膜囊细菌病原学特征及术前用药效果.方法 对230例(450只眼)LASIK、LASEK患者于术前用药前和用药后进行结膜囊细菌培养并行药敏试验.结果 450只眼用药前结膜囊细菌培养有240只眼(占53.33%)培养出细菌,其中表皮葡萄球菌138只眼(占57.5%),棒状杆菌73只眼(占30.78%),表皮葡萄球菌+棒状杆菌共20只眼(占8.33%),溶血链球菌9只眼(占3.75%).用药后341只眼中有6只眼(占1.76%)培养出细菌,为微球菌.所培养出的细菌均对左氧氟沙星敏感,术后均未感染.结论 准分子手术患者术前有必要局部滴用有效的抗生素滴眼液清洁结膜囊以预防术后感,增加手术的安全性,降低手术风险.     

加替沙星和左氧氟沙星治疗细菌性结膜炎的疗效对比研究

目的 探讨氟喹诺酮类抗生素加替沙星和左氧氟沙星治疗细菌性结膜炎的临床疗效和安全性.方法 采用多中心、随机、双盲、对照试验.2006年8月至2007年10月,在复旦大学附属眼耳鼻喉科医院、河南省眼科研究所、温州医学院附属视光医院、南京医科大学第一附属医院、第四军医大学西京医院、西安交通大学医学院第二附属医院6所医院进行研究.以盐酸左氧氟沙星滴眼液为有效对照,将诊断为细菌性结膜炎的235例(235只眼)患者按随机区组法分入两组:试验组118只眼,对照组117只眼,试验组滴用加替沙星,对照组滴用左氧氟沙星,每组给药方法均为每次2滴,第1-2天,每2小时滴1次,8次/d;以后每4小时滴1次,4次/d,滴入结膜囊内,疗程为7 d.所有人组患者均在试验开始前及试验结束后行结膜囊细菌培养及药物敏感试验,并在用药前和用药后第3-5天、第6-8天分别对症状、体征观察进行综合评分以及评价其安全性.采用协方差分析方法、CMH X2方法、Pearson X2检验、Fisher检验对实验数据进行统计学分析.结果 加替沙星组和左氧氟沙星组的有效率分别为94.0%(110/117只眼)和93.8%(106/113只眼),差异无统计学意义(X2=0.052,P=0.8201).加替沙星组和左氧氟沙星组的细菌清除率分别为94.1%(80/85只眼)和92.5%(74/80只眼),两组比较差异无统计学意义(P=0.3470).用药后第3～5天症状体征综合评分下降幅度加替沙星组为(4.436±2.310)分,左氧氟沙星组为(3.814±1.962)分,差异有统计学意义(F=7.280,P=0.0075).用药后第6～8天症状体征综合评分下降幅度加替沙星组为(7.487 ±2.821)分,左氧氟沙星组为(6.912±2.911)分,差异有统计学意义(F=4.060,P=0.0452).视力及局部用药后耐受性评分在两组之间无显著差异(视力F=1.04,P=0.3080;局部用药后耐受性X2=0.1372,P=0.7111).根据全部患者细菌培养结果,细菌性结膜炎致病菌以革兰阳性菌为主(共检测出革兰阳性菌20种,革兰阴性菌8种),加替沙星对革兰阳性菌的最低抑菌浓度低于左氧氟沙星(表皮葡萄球菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、甲型溶血性链球菌等).结论 加替沙星滴眼液对细菌性结膜炎有良好的治疗作用,能够有效清除致病菌,起效快,作用强,且体外抗菌活性高,不易产生耐药性,具备良好的安全性和眼部耐受性.     

白内障超声乳化术围手术期结膜囊细菌培养及药物敏感性的调查研究

目的调查白内障超声乳化术围手术期患者结膜囊内细菌及其对药物的敏感情况,从而指导抗生素的合理应用以及降低感染性眼内炎的发病率。方法将300例(300眼)白内障住院患者,分为术前1个月未用抗生素滴眼液组(未用药组)和术前1 d给予抗生素滴眼液组(用药组),各150例(150眼);对2组分别在术前、术后第1天拆开眼垫换药前的结膜囊进行细菌培养及药物敏感性试验。结果术前未用药组和用药组结膜囊细菌培养各150例,检出病原菌均以革兰阳性球菌(87.2%、78.3%)为主,其中在革兰阳性球菌中主要是表皮葡萄球菌和金黄色葡萄球菌;术后未用药组和用药组结膜囊细菌培养各150例,检出病原菌以革兰阳性球菌(87.5%、80.0%)为主,其中在革兰阳性球菌中主要是表皮葡萄球菌和金黄色葡萄球菌。药敏结果显示:细菌对头孢西丁、庆大霉素、左氧氟沙星、红霉素、妥布霉素、氧氟沙星和氯霉素的敏感性呈现逐渐下降趋势,而对氧氟沙星、左氧氟沙星、红霉素有较高的耐药性。结论表皮葡萄球菌和金黄色葡萄球菌是白内障围手术期结膜囊内的主要菌株,通过常规做细菌培养及药敏试验显示细菌对头孢西丁、庆大霉素、左氧氟沙星、红霉素、妥布霉素、氧氟沙星和氯霉素的敏感性呈现逐渐下降,而对氧氟沙星、左氧氟沙星、红霉素有较高的耐药性,所以合理、及时地选择敏感的抗生素可以指导抗生素的合理应用以及预防术后感染性眼内炎的发生,增加手术的安全性,降低手术风险。     

老年人内眼手术前结膜囊细菌培养的分析

目的 了解老年人内眼手术前的结膜囊细菌情况。方法 对老年患者279例(350眼)术前进行结膜囊细菌培养，并对阳性者作药敏试验。结果 术前结膜囊细菌培养阳性率为17．43％。药敏试验结果：敏感药物为氧氟沙星、先锋霉素、庆大霉素等。结论 老年人内眼手术前用敏感抗生素滴眼，并常规行结膜囊细菌培养及药敏试验是必要的。     

50g/L聚维酮碘溶液对降低白内障术前结膜囊病原菌的有效性

目的:评价50g/L聚维酮碘溶液对降低白内障术前结膜囊病原菌的有效性。方法:选择行白内障超声乳化联合人工晶状体植入术的患者45例58眼,选取术眼在入院时,点用加替沙星眼液后及使用聚维酮碘结膜囊消毒后三个时间点,取结膜囊拭子送检进行细菌培养。结果:入院时,点用加替沙星滴眼液后及50g/L聚维酮碘点眼消毒后细菌培养的阳性率分别为:79.3%,41.9%,3.4%,培养阳性率明显逐渐降低。结论:眼科临床所用消毒剂50g/L聚维酮碘术前点眼消毒可有效抑制结膜囊细菌,避免术后眼内炎的发生。     

白内障术前滴用氧氟沙星滴眼液对结膜囊细菌培养的影响

目的:观察老年性白内障患者术前应用氧氟沙星滴眼液对结膜囊细菌培养的影响。方法:老年性白内障患者30例60眼,随机分成两组:对照组15例30眼,3g/L氧氟沙星点眼组15例30眼,平均点眼5次,l滴/次。观察点药前,点药l,2,3d,结膜囊内细菌的变化。结果:点药前,点药1,2,3d,结膜囊内细菌落积分的变化:对照组,51,51,33,42;3g/L氧氟沙星点眼组,51,30,9,0。配对t检验统计分析,点药3d,P=0.043。结膜囊内细菌检出率的变化:对照组,60%,60%,40%,50%;3g/L氧氟沙星点眼组,60%,30%,10%,0。χ2检验,点药3d,P<0.01。结论:老年性白内障患者术前应用氧氟沙星滴眼液点眼,3d可以达到结膜囊内无细菌。     

氧氟沙星点眼及结膜囊冲洗预防LASIK术后感染作用的探讨

目的探讨0.3%氧氟沙星滴眼液手术前点眼以及结膜囊冲洗对预防LASIK术后感染的作用。方法行准分子激光治疗的近视眼患者92例183眼,手术前结膜囊冲洗前后分别做结膜囊分泌物细菌培养。结果未点眼组和点眼1、2、3、4d组结膜囊冲洗前细菌培养阳性率分别为21.21%(7/33)、19.19%(19/99)、22.22%(4/18)、5.88%(1/17)和31.25%(5/16);点眼1、2、3、4d组与未点眼组相比,经统计学处理,差异均无显著性(P>0.05,χ2=3.294)。结膜囊冲洗前细菌培养阳性率19.67%,冲洗后阳性率4.92%,经统计学处理具有显著性差异(P<0.01,χ2=18.47)。在培养阳性的45眼中,葡萄球菌39眼,占87.7%,杆菌6眼,占13.3%。结论结膜囊细菌培养阳性者中以葡萄球菌为主,LASIK术前充分的结膜囊冲洗是预防术后感染的重要措施,抗生素点眼应选择对球菌作用强兼顾杆菌的有效抗生素或联合用药。     

Comparative Study of the Disinfection Effects of Three Types of Conjunctiva Sac Irrigations

 PURPOSE:The antiseptic effectiveness of 5% anerdian III, 0.016% gentamicin, and 0.5% tobramycin solutions in pre-surgical irrigation of conjunctival sac were compared.   METHODS:A total of 295 cataract patients (302 eyes) who had undergone phacoemulsification aspiration combined with intraocular lens insertion (IOL) were recruited in this prospective study. Operative eyes were given 0.3% levofloxacin eye drops for 3 days and then were randomized into three treatment groups:, anerdian (A), gentamicin (B) and tobramycin (C). The patients received conjunctival sac irrigation using the respective solutions at 10 minutes preoperatively. Conjunctival sac sampling was performed before and after irrigation and the samples were used for subsequent bacterial culture and swab tests. The positive culture rate was used as the main outcome. RESULTS: The positive rates of bacterial culture before conjunctival sac irrigationwere 17.31% (18 eyes) in group A, 13.86% (14 eyes) in group B and 17.3% (14 eyes) in group C. Post irrigation, the positive rates in the three groups decreased to 5.76% (6 eyes), 5.94% (6 eyes) and 7.22% (7 eyes), respectively. The positive rates among the three groups did not differ significantly. However, the positive rate in group A only significantly differed before and after the irrigation (P &;lt;0.05). No toxic or allergic reactions were observed on the ocular surface of any patient after irrigation.  CONCLUSION:The antiseptic effects of the three types of conjunctival sac irrigations did not differ.     

0.5%左氧氟沙星与0.3%加替沙星及0.3%乳酸左氧氟沙星的房水药物浓度研究

目的 探讨人眼分别滴用0.5%左氧氟沙星、0.3%加替沙星及0.3%乳酸左氧氟沙星后房水中药物浓度差异.方法 采用随机、双盲、平行研究方法.选取2006年8月至2007年2月在浙江大学医学院附属第二医院眼科中心预行白内障超声乳化术的老年白内障患者150例(150只单侧眼),使用随机数字表法分为3个大组:0.5%左氧氟沙星组(50只眼)、0.3%加替沙星组(50只眼)、0.3%乳酸左氧氟沙星组(50只眼),每个大组冉使用随机排列表分为5个亚组,每个亚组10只眼.按不同大组,术前分别局部给予0.5%左氧氟沙星、0.3%加替沙星或0.3%乳酸左氧氟沙星滴眼,总共4次,每次间隔15 min.手术时按不同亚组,分别于最后1次给药后15、30、60、120、180 min时抽取房水多于100 μl,然后用加样器准确定量至100μl置于带塞试管中.全部标本采用高效液相色谱法测定房水中药物浓度.采用单因素方差分析(ANOVA)对不同时间点的3种药物浓度进行统计学分析,两两之间差异比较采用t检验进行分析.结果 给药后15、30、60、120、180 min房水内0.5%左氧氟沙星浓度(1.61±0.48)、(2.41±0.80)、(2.93±0.50)、(2.56±0.63)、(1.87±0.88)mg/L分别高于对应时间点的0.3%加替沙星浓度(0.70±0.18)、(1.29±0.54)、(1.59±0.67)、(1.41±0.50)、(1.13±0.28)mg/L及0.3%乳酸左氧氟沙星浓度(0.55±0.39)、(1.15±0.42)、(1.38±0.49)、(1.02±0.33)、(0.55±0.31)m.g/L,差异均有统计学意义(F=23.64,12.82,21.13,25.00,12.22;P均<0.05).0.3%加替沙星和0.3%乳酸左氧氟沙星的房水药物浓度经检验在15、30、60、120 min无明显差异(t=1.09,0.68,0.83,2.00;均P>0.05).在180 min时0.3%加替沙星的房水药物浓度高于0.3%乳酸左氧氟沙星,差异有统计学意义(t=4.36,P<0.05).结论 人眼滴用0.5%左氧氟沙星、0.3%加替沙星及0.3%乳酸左氧氟沙星后,以滴用0.5%左氧氟沙星后房水的药物浓度最高.     

Comparative clinical study of conjunctival toxicities of newer generation fluoroquinolones without the influence of preservatives

AIM: To compare the conjunctival epithelial toxicities of three newer-generation fluoroquinolones without preservatives. METHODS: In a prospective, randomized, double blind comparative study, 47 eyes of 47 patients with a primary pterygium were enrolled, and divided randomly into three groups (levofloxacin 0.5%, gatifloxacin 0.3%, and moxifloxacin 0.5%). After pterygium surgery with the same conjunctival autograft technique, each patient maintained a regimen with a randomly assigned fluoroquinolone eye drop. Patients were examined every other day after surgery until the epithelium had completely healed. Photos were taken and used to measure the area of residual epithelial defects. Conjunctival healing time and speed (initial defect area/healing time (mm2/d) compared in each group using Kruskal-Wallis tests. RESULTS: There were no significant differences in mean age, gender, and conjunctival defect size of the donor site between these groups. However, the mean of conjunctival healing time and speed were statistically different in each group. The mean of conjunctival epithelial healing time was 8.93±2.69d (levofloxacin group), 10.31±2.96d (gatifloxacin group), and 13.50±4.10d (moxifloxacin group), P=0.006. The mean conjuctival epithelial healing speed was 6.18±1.39 mm2/d (levofloxacin group), 5.52±1.68 mm2/d (gatifloxacin group), and 4.40±1.30 mm2/d (moxifloxacin group), P=0 .003. CONCLUSION: Without the influence of preservatives, levofloxacin and gatifloxacin might be less toxic to the regeneration of conjunctival epithelial cells and cause a faster conjunctival wound healing relative to moxifloxacin.     

加替沙星滴眼液治疗细菌性结膜炎临床分析

目的 探讨加替沙星滴眼液治疗细菌性结膜炎的临床效果.方法 加替沙星组和氧氟沙星组各为120例,合计240例.采用计算机编程随机法,随机双盲对照试验.患者的纳入应能满足所有入选及排除标准,随机分为加替沙星组和氧氟沙星组,分别给予加替沙星滴眼液和相同浓度对照药氧氟沙星滴眼液,疗程7～14天.加替沙星滴眼液组:每日5次,每次1～2滴,滴入结膜囊内,氧氟沙星滴眼液组:每日5次,每次1～2滴,滴入结膜囊内,随诊观察.结果 本研究共分离临床敛病菌67株,其对加替沙星、氧氟沙星、左氧氟沙星和环丙沙星的敏感率分别为98.51%、85.07%、95.52%、78.79%.表明加替沙星的细菌敏感率最高,与氧氟沙星比较,差异有统计学意义.加替沙星滴眼液治疗细菌性结膜炎的疗效不低于氧氟沙星滴眼液.结论 结果表明,加替沙星滴眼液抗菌谱广、抗菌活性强,与氧氟沙星滴眼液疗效相当,安全性好,适于作为细菌性结膜炎的治疗用药.同时对革兰阳性菌和革兰阴性菌感染的眼表疾病,都有一定的治疗效果.

Abstract：

Objective To study the clinical efficacy of gatifloxacin eye drops for bacterial conjunctivitis.Methods A total of 240 cases that diagnosed as bacterial conjunctivitis were randomly divided into test group (gatifloxacin) and control group (floxacin).A random double-blind and paralled study was conducted on 120 cases with gatifloxacin and floxacin eye drops for bacterial conjunctivitis.The drug delivery into conjunctival sac was performed at 7-14 days (one-two drops per time, five times per day).Results Sixty-seven clinical common pathogenic bacteria were separated from the study.The antibacterial activity of gatifloxacin,floxacin, levofloxacin, ciprofloxacin was 98.51%, 85.07%, 95.52%, and 78.79% respectively.The antibacterial activity of gatifloxacin was the highest, and the statistic difference between gatifloxacin and floxacin was found.The effect of gatifloxacin eye drops was not worse than floxacin eye drops.Conclusions The gatifloxacin eye drops has characteristics with broad spectrum, powerfull antibacterial activity.The linical effect of gatifloxacin eye drops is the same with floxacin eye drops.Gatifloxacin eye drops are safe and can be used to treat bacterial conjunctivitis.It has comparatively theropic value of ocular surface disease with Gram-positive bacterial and Gram-negetive bacterial.     

加替沙星和左氧氟沙星对急性细菌性结膜炎有效性与安全性的Meta分析

目的:运用Meta分析系统评价加替沙星滴眼液和左氧氟沙星滴眼液对急性细菌性结膜炎的临床疗效及安全性。方法:按Cochrane系统评价方法,以“加替沙星”“左氧氟沙星”“急性细菌性结膜炎”为关键词,检索Embase、Cochrane library、Pubmed、Medline、中国知网数据库、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库,从建库开始时间检索至2021-03-01。纳入比较加替沙星滴眼液和左氧氟沙星滴眼液治疗急性细菌性结膜炎的随机对照研究。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,使用RevMan5.3统计软件进行Meta分析,运用Stata12中Egger检验分析发表性偏倚,并按照GRADE系统评估证据水平。结果:共纳入10项随机对照研究,合计1149例患者。对照组采用左氧氟沙星滴眼液治疗,试验组采用加替沙星滴眼液滴眼液治疗。Meta分析结果表明加替沙星滴眼液组对于急性细菌性结膜炎临床有效率优于左氧氟沙星滴眼液组(OR=3.75,95%CI:2.52~5.58,P<0.00001),Egger检验提示存在发表偏倚,且GRADE评价结果显示该证据水平为“很低”;加替沙星滴眼液组药物不良反应发生率低于左氧氟沙星滴眼液组(OR=0.37,95%CI:0.19~0.71,P=0.003);Egger检验提示不存在发表偏倚,且根据GRADE方法评价,该证据水平为“低”。结论:加替沙星滴眼液对于急性细菌性结膜炎的疗效优于左氧氟沙星滴眼液,且不良反应发生率较低;但由于纳入的研究证据水平较低,需要更多的多中心、随机双盲临床试验,从而提高加替沙星滴眼液治疗急性细菌性结膜炎临床疗效的证据强度。     

Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora

PURPOSE: To compare efficacy of a 1-day versus 3-day application of topical levofloxacin in reducing ocular surface bacteria. METHODS: In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3. RESULTS: A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000). CONCLUSIONS: The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.     

A prospective randomized study to determine the efficacy of preoperative topical levofloxacin in reducing conjunctival bacterial flora

PURPOSE: To compare the efficacy of topical levofloxacin in combination with povidone-iodine irrigation vs povidone-iodine (PVI) alone in reducing conjunctival bacteria. DESIGN: Prospective, randomized, controlled trial. METHODS: One hundred and forty eyes of 140 patients scheduled to undergo intraocular surgery eyes were randomized to either group 1 or 2 (70 each). Whereas group 1 eyes had no prophylactic antibiotic, eyes in group 2 received topical treatment with one drop of 0.5% levofloxacin four times on the day before surgery. Both groups underwent irrigation of the fornices with 1% PVI. Conjunctival swabs were inoculated on solid and broth culture media to determine bacterial growth. RESULTS: Of 132 eyes evaluated, baseline culture analysis in thioglycolate demonstrated positive culture results in 55 (84.6%) of 65 eyes from group 1, similar to 55 (82.1%) of 67 eyes in group 2 (P = .697). Before surgery, 57 (87.7%) of 65 eyes in group 1 had positive culture results, compared with 50 (74.6%) of 67 eyes in group 2 (P = .055). After irrigation with PVI, 20 (30.8 %) of 65 eyes in group 1 had positive culture results, compared with only eight (11.9%) of 67 eyes in group 2 (P = .008). After surgery, 15 (23.1%) of 65 eyes in group 1 and six (9.0%) of 67 eyes in group 2 had positive culture results (P = .027). CONCLUSIONS: Our study shows an enhanced effect of using topical levofloxacin in combination with PVI irrigation to reduce conjunctival bacteria in patients undergoing intraocular surgery.     

5%安尔碘Ⅲ型稀释液对白内障术前结膜囊病原菌的消毒效果

目的 对比5%安尔碘Ⅲ型稀释液与0.5%妥布霉素稀释液用于白内障术前结膜囊冲洗的消毒效果.方法 选择90例行白内障超声乳化联合人工晶状体植入术的患者共102只眼,术眼先用0.3%左氧氟沙星滴眼液点眼3d,再随机分入安尔碘组与妥布霉素组,于冲洗前后,取结膜囊拭子送检进行细菌培养及药物敏感性试验;并在手术与术后随防中观察术眼眼表改变.结果 结膜囊冲洗前细菌培养阳性率:安尔碘组为20%(10只眼),妥布霉素组为17.3%(9只眼);冲洗后阳性率:安尔碘组为0;妥布霉索组为5.8%(3只眼),冲洗后两组阳性率对比无统计学意义.冲洗前后细菌培养阳性中以表皮葡萄球菌占多数.所有病人术中及术后随防半年均未观察到角结膜药物毒性或过敏反应;两组病人基础泪液分泌(Sit)与泪膜破裂时间(BuT)在术后1d对比无统计学差异;应用安尔碘冲洗结膜囊的白内障术后病人术后7d、30d、半年的Sit与BUT值与文献报道接近;培养的细菌对部分抗生素存在耐药现象.结论 5%安尔碘Ⅲ型稀释液可以安全、有效地应用于白内障术前结膜囊消毒.