Prospective evaluation of external ocularmicrobial growth and aqueous humor contamination during cataract surgery

Purpose:To analyze the route of aqueous humor contamination leading to thedevelopment of postoperative endophthalmitis.Setting:Department of Ophthalmology, University of Helsinki, Finland.Methods:Forty-nine eyes of 49 patients (31 having phacoemulsification and 18 extracapsularcataract extraction [ECCE]) participated in the study. Four bacterial cultures were taken: preoperative conjunctival swab, lid margin culture, intraoperative lacrimal lake sample, and immediate postoperative anterior chamber fluid sample.Results:Preoperative lid margin cultures were positive in 59.2% of eyes, conjunctival cultures in 69.4%, and lacrimal lake cultures in 24.9%. Four aqueous humor samples (8.2%) showed bacterial growth in the anterior chamber aspirate: 3 in the phacoemulsification and 1 in the ECCE group. The bacteria isolated in this study, Staphylococcus epidermidis and Propionibacterium acnes (2 positive isolates each) were sensitive to the preoperative topical antibiotics used. No aqueous humor sample or any from other locations showed gram-negative microbe growth. The most frequently recovered microbes in all samples collected from the 3 other sources were S epidermidis and other coagulase-negative staphylococcus species, followed by P acnes and other propionibacterium species, Staphylococcus aureus, and diptheroids.Conclusion:The ocular surface significantly contributed fo the transmission ofmicrobes into the eye during cataract surgery. These microbes could not be eradicated by topical preoperative antibiotics. However, no patient developed postoperative endophthalmitis. Natural defense mechanisms appear to fend off a minor inoculum with these microbes of relatively low pathogenicity.     

Microbial contamination of the anterior chamber during phacoemulsification

PURPOSE: To study the nature and frequency of anterior chamber contamination during phacoemulsification. SETTING: Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. METHODS: Eighty eyes of 80 patients having routine phacoemulsification cataract surgery were recruited into this prospective study. Bacterial cultures from the intraoperative anterior chamber aspirates from the patients were assessed. RESULTS: Anterior chamber fluid aspirates were positive for bacteria in 37 eyes (46.25%). Coagulase-negative Staphylococcus was the most common aerobe and Propionibacterium acnes, the most common anaerobe. CONCLUSION: Results indicate that phacoemulsification has no proven advantage over conventional extracapsular cataract extraction in reducing intraoperative bacterial contamination.     

Anterior chamber contamination during phacoemulsification and manual small-incision cataract surgery

PURPOSE: To compare the per-operative contamination of anterior chamber among eyes undergoing manual small-incision cataract surgery (MSICS) and phacoemulsification (PE). DESIGN: Prospective, randomized, interventional clinical trial. METHODS: In this study conducted at a tertiary-care center in southern India, 150 eyes undergoing cataract surgery were randomly allocated to undergo MSICS (group A, 75 eyes) and PE (group B, 75 eyes). Aqueous samples were taken before and at the end of surgery. Collected material was subjected to standard microbiological analysis. No preoperative antibiotics were used, but povidone-iodine 5% drops were instilled before surgery. Main outcome measures studied were the incidence of positive cultures in aqueous samples obtained from eyes in both groups. RESULTS: The incidence of anterior chamber contamination in the MSICS group (4%) did not significantly differ from the PE group (2.7%; P = .65). CONCLUSIONS: Incidence of anterior chamber contamination is similar among eyes undergoing MSICS and PE.     

Bacterial contamination in the anterior chamber after povidone-iodine application and the effect of the lens implantation device

PURPOSE: To assess the incidence of anterior chamber bacterial contamination during cataract surgery, and compare results of injector implantation and forceps implantation of foldable intraocular lenses (IOLs). SETTING: Department of Ophthalmology and Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary. METHODS: This prospective randomized controlled clinical study comprised 97 eyes of 96 patients. Antibiotic eyedrops were not used; however, povidone-iodine 10% solution was used to prepare the eyebrow and eyelids and povidone-iodine 5% to disinfect the ocular surface. A Steri-Drape (3M) was used to surround the eye. Aqueous fluid samples were aspirated from the anterior chamber at the beginning and the end of surgery. The samples were cultured for 14 days under aerobic and anaerobic conditions simultaneously. Cataract surgery was performed using a sutureless, superotemporal, clear corneal phacoemulsification technique. The IOL was implanted with an injector (n = 47) or a forceps (n = 50), with the instrument randomly selected. The frequency of positive bacterial cultures with each implantation method was compared using the Fisher exact test. RESULTS: Bacteria were found in the conjunctival samples in 21 eyes (21.65%) before povidone-iodine application and in 4 eyes (4.12%) after disinfection. The anterior chamber sample before surgery was culture positive for Staphylococcus epidermidis in 2 eyes and for Micrococcus luteus in 1 eye. After surgery, the culture was positive for S epidermidis in 1 eye (2.15%) in the injector group and 1 eye (2.00%) in the forceps group (P = .74). Neither sample came from an eye that had a positive culture preoperatively. There were no intraoperative complications. CONCLUSIONS: In uneventful clear corneal phacoemulsification, meticulous technique can prevent antibiotic use during surgery. No difference in anterior chamber bacterial contamination was found between IOL implantation using an injector or a forceps.     

Bacterial contamination: epidemiology in cataract surgery

PURPOSE: To evaluate anterior chamber (AC) bacterial contamination at the end of cataract surgery in a large series of patients, to determine the influence of operative technique on ocular contamination. METHODS: Retrospective study of 2,624 patients undergoing cataract extraction, 354 extracapsular cataract extraction (ECCE) and 2,270 phacoemulsification. Anterior chamber aspirates were performed on completion of surgery for microbiological studies. RESULTS: One hundred and thirty two patients (5%) had culture-positive anterior chamber aspirates. Coagulase-negative Staphylococcus, Propionibacterium sp. and Corynebacterium sp. were the most commonly isolated organisms. The AC contamination rates during ECCE (5.6%) and phacoemulsification (4.7%) were not statistically different. There was a statistically significantly higher risk of AC contamination in eyes receiving an intraocular lens (IOL) with polypropylene haptics (9.9%) than in eyes receiving the same IOL with polymethylmethacrylate haptics (4.4%). CONCLUSION: Surgical technique had no statistically significant effect on ocular contamination. Polypropylene haptics IOLs were associated with a higher risk of bacterial contamination.     

Microbiologic analysis of aqueous humor in phacoemulsification.

PURPOSE: This study was designed as a microbiologic survey of the fluids aspirated from the anterior chamber at the end of cataract extraction performed by phacoemulsification, and to correlate the contamination rate of the anterior chamber to the surgical technique used. METHODS: One hundred and one consecutive patients (126 eyes) who underwent cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation were included in the study. Microscopical examination, culture, and determination of the number of colonies were carried out on the bacteria and fungi in the anterior chamber fluids aspirated at the end of surgery, before final suture placement. RESULTS: Anterior chamber fluids yielded positive cultures in nine specimens (8.14%), six of which were identified as coagulase-negative staphylococci. Quantification disclosed colony counts ranging between 2-10 and 10-40 per mL. CONCLUSIONS: Preliminary results in a small population show that the contamination of the aqueous humor is significantly less frequent if the cataract extraction is performed by phacoemulsification.     

Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery

PURPOSE: To determine the incidence of bacterial contamination of the anterior chamber after phacoemulsification cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia. METHODS: Ninety-eight consecutive eyes of 96 patients having phacoemulsification cataract surgery with IOL implantation were included in this prospective study. Two intraoperative anterior chamber aspirates were obtained from each patient, 1 taken at the start and the other at the conclusion of surgery. In addition, preoperative and postoperative conjunctival swabs were acquired. The 4 specimens were cultured using direct culturing techniques under aerobic and anaerobic conditions for 14 days. No preoperative antibiotics were used. RESULTS: The incidence of intraoperative anterior chamber contamination was 0% (95% confidence interval, 0%-3.7%) as all intraoperative anterior chamber samples proved culture negative. Sixty-five percent of the preoperative conjunctival swabs were positive for growth, with corynebacteria, coagulase-negative staphylococci, and Propionibacterium acnes being the most frequently cultured organisms. Sixteen percent of the postoperative conjunctival swabs were positive for growth, with corynebacteria and coagulase-negative staphylococci being the most common bacteria. One patient developed culture-positive postoperative endophthalmitis; using pulsed-field gel electrophoresis for further typing, the implicated Staphylococcus epidermidis was indistinguishable from that isolated from the patient's preoperative conjunctival swab. CONCLUSIONS: The bacterial contamination rate of the anterior chamber after phacoemulsification and IOL implantation was extremely low. Additional findings support the conjunctiva as being a primary source of bacteria causing postoperative endophthalmitis as well as the ability of povidone-iodine to reduce the conjunctival bacterial load.     

Intraocular contamination during extracapsular cataract extraction with intraocular lens implantation

Ocular bacterial contamination has been studied in 45 eyes that underwent cataract surgery. The following samples were taken: (1) eyelid margin swab; (2) conjunctival swab; (3) aqueous humor after initial anterior chamber penetration; (4) anterior capsule fragment after capsulorrhexis or capsulotomy; (5) cortical lens material; (6) anterior chamber fluid after lens implantation. The percentages of contaminated samples were 15.5, 13.3, 0.0, 11.1, 13.3 and 6.6, respectively. There was a significant difference between the incidence of positive cultures in the aqueous humor at the time of incision and in subsequent intraocular samples. Positive cultures were found in 13 out of 45 eyes, only gram-positive organisms were recovered and coagulase-negative staphylococci were the most common (78.5% of the isolates). These results confirm previous reports on intraocular contamination during cataract surgery.     

Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty

AIM:To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty (PKP).METHODS:In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL). The main outcome measures were anterior chamber reaction, best corrected visual acuity (BCVA), corneal endothelial cell count (ECC), and central corneal thickness (CCT).RESULTS:Fifty-five patients were recruited (26 males, 29 females). The mean age was 54.36±4.97y (range 45-64y). All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively, which was statistically significant (P<0.001). One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33±1.01s. The mean ECC was 2340.20 cells/mm² preoperatively and 1948.75 cells/mm² 1mo postoperatively (P<0.001). The increase of 21.09 μm in postoperative pachymetry 1mo after surgery was statistically significant (P<0.001).CONCLUSION: No untoward effects were observed after intracameral injection of moxifloxacin (0.5 mg/0.1 mL) in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.     

Early post-phacoemulsification hypotony as a risk factor for intraocular contamination: in vivo model

PURPOSE: To observe cataract wound dynamics and determine the risk for intraocular contamination under induced conditions of early postoperative hypotony after anterior chamber decompression for high intraocular pressure (IOP) spikes after uneventful phacoemulsification surgery. SETTING: Department of Ophthalmology, Queen's Hospital, Burton-on-Trent, United Kingdom. METHODS: In a prospective case series, 30 patients were treated with anterior chamber decompression for elevated IOP (>35 mm Hg) 1 to 2 hours after uneventful phacoemulsification through clear corneal temporal incisions. A drop of 2% fluorescein was instilled in the conjunctival sac before aqueous release to study the ocular fluid movements during and after the decompression procedure. The patterns of fluorescein movement were observed and photographed under cobalt blue light. RESULTS: Fluorescein staining of the entire corneal tunnel was observed in all 30 eyes after decompression. An immediate fluorescein flare was observed in the anterior chamber after aqueous release in 24 eyes (80%) (P<.001). Observations over several seconds after decompression found a frank influx of fluorescein-stained fluid into the anterior chamber in 12 eyes (40%) (P<.001), giving rise to an "inverse Seidel's test." An intermittent ingress of fluorescein-stained fluid continued for several minutes after the procedure in 6 eyes (20%) (P<.05). CONCLUSIONS: An incompetence of clear corneal cataract wound with intraocular contamination was observed during the period of induced hypotony after anterior chamber decompression in the early post-phacoemulsification period.     

白内障超声乳化术中灌注液加入头孢呋辛对房水细菌污染的控制作用

目的　评估白内障超声乳化术中灌注液加入头孢呋辛对房水细菌污染的控制作用。方法　选取2017年5月至8月在青岛眼科医院接受白内障超声乳化手术治疗的患者为研究对象，根据术中灌注液的不同分为两组，对照组99例（102眼）使用平衡盐溶液灌注液；试验组93例（100眼）使用含头孢呋辛（1.5 g·L^-1）的平衡盐溶液灌注液。两组患者分别于入院时（未局部应用抗菌药物前）、术前（聚维酮碘冲洗结膜囊后）行结膜囊细菌培养，于手术结束时行房水细菌培养，并对两组患者结膜囊及房水细菌培养结果进行比较。结果　入院时，对照组与试验组结膜囊细菌培养阳性率为50.00%和51.00%，差异无统计学意义（χ²=0.020，P=0.887）；术前，对照组与试验组结膜囊细菌培养阳性率为25.5%和27.0%，差异无统计学意义（χ²=0.059，P=0.807）；手术结束时，对照组与试验组房水细菌培养阳性率为5.9%和0，差异有统计学意义（F=6.062，P=0.029）。结论　使用含头孢呋辛（1.5 g·L^-1）的灌注液能减少白内障超声乳化术的房水细菌污染。     

白内障术后眼内炎的治疗分析

目的：探讨白内障术后眼内炎的治疗方案及效果。方法：对我院2006-01/2010-12白内障摘除术＋人工晶状体植入术的21973例28722眼患者的资料（超声乳化20937例27521眼,囊外摘除术1036例1201眼）进行回顾性分析。结果：在全部术眼中,感染性眼内炎11眼,感染率为0.04%,9眼发生于超声乳化术后,2眼发生于白内障囊外摘除术后。共有5眼病原菌培养阳性,其中表皮葡萄球菌2眼,金黄色葡萄球菌,浅绿色气球菌,真菌各1眼。感染发生于白内障术后2wk以内者占73%（8/11）,房水混浊或前房积脓者行前房灌洗＋玻璃体腔注射万古霉素;前房积脓合并明显玻璃体混浊或经前房灌洗＋玻璃体腔注射万古霉素治疗观察1～2d感染加重者行前房灌洗＋玻璃体切割术。治疗后11眼均保住眼球。结论：白内障术后眼内炎经常发生于白内障术后2wk以内,经及时有效的治疗可控制感染发展,保留部分有用视力;前房灌洗＋玻璃体腔注射万古霉素必要时联合玻璃体切割术是有效的治疗方法。     

The effect of anterior chamber maintainer on anterior chamber contamination

PURPOSE: To evaluate the effect of anterior chamber continuous infusion maintainer system on the contamination of anterior chamber in phacoemulsification surgery. METHODS: Clear corneal phacoemulsification surgery was performed in 132 eyes of 132 randomly selected patients with cataract who were divided into two groups of 66 eyes according to the use of an anterior chamber maintainer (ACM) system. The fluid specimens were taken from anterior chamber in the beginning and at the end of the surgery. They were transferred under anaerobic conditions and investigated by culturing onto blood agar and thiogluconate broth media. Differences between the two groups with respect to contamination of the specimens were investigated. RESULTS: The mean age of the group undergoing surgery without a maintainer system (Group A) was 63 +/- 10 years (min = 41, max = 80) versus 59 +/- 10 years (min = 33, max = 80) in the other group (Group B) in which the maintainer was used during surgery. In the postoperative specimen, Micrococcus species were isolated from one eye (1.5%) in Group A and S. pyogenes in one eye (1.5%) from Group B. Mean follow-up interval was 12 +/- 6 (min = 4, max = 28) months. CONCLUSIONS: The use of ACM system in clear corneal phacoemulsification surgery carries no additional risks as far as contamination is concerned.     

Bacterial contamination of anterior chamber during IOL surgery

PURPOSE: To study the nature and frequency of bacterial contamination during cataract surgery. METHODS: The preoperative smears from the conjunctiva and anterior chamber (AC) fluid aspirates during extra-capsular cataract surgery (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in 40 eyes were analysed for aerobic and anaerobic bacteria. Any change in the bacterial strains isolated before and after cataract surgery was also studied. RESULTS: AC fluid aspirates were positive for bacteria in 15 eyes (37.5%). Coagulase-negative Staphylococcus was the most common aerobe (39.4%) and Propionibacterium acnes the most common anaerobe. Of the 15 cases with positive AC fluid cultures, 6 showed an organism in the AC aspirate different from the conjunctival smear. CONCLUSION: Clinically there was no endophthalmitis in any of the eyes. Factors such as preoperative antibiotic use, the antibacterial properties of aqueous, or low inoculum size could explain this. The preoperative conjunctival smear may not be useful in predicting the AC fluid contamination or outcome of cataract surgery.     

抗青光眼术后浅前房的前房重建手术

目的 探讨青光眼滤过术后浅前房的手术方法和效果.方法 取17例抗青光眼术后浅前房患者经保守治疗无效,有7只眼发生脉络膜脱离,5只眼行脉络膜上腔放液+前房成形术,1只眼行白内障超声乳化及人工晶状体植入术及前房成形术,1只眼行脉络膜上腔放液+白内障超声乳化及人工晶状体植入术+前部玻璃体切割术+前房成形术.有9只眼发生恶性青光眼,1例行抽玻璃体水囊联合前房成形术,3例行前部玻璃体切除及后囊切开联合小梁切除及丝裂霉素联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除术中发生脉络膜脱离及脉络膜上腔出血行前部玻璃体切除联合玻璃体腔放液,2只眼行前部玻璃体切除联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除联合前房成形术,术后前房仍浅又行白内障超声乳化及人工晶状体植入及后囊膜切开及房角分离术,1例为视网膜脱离术后硅油存留眼行白内障超声乳化联合虹膜周边切除术及前房成形术.结果 术后前房恢复时间脉络膜脱离组行脉络膜上腔放液及前房成形术平均为5.6d,恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开组前房恢复时间最短,平均为1.1d.结论 恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开治疗有效快速.     

白内障超声乳化联合房角分离术治疗闭角型青光眼

目的：分析白内障超声乳化吸出+人工晶状体植入联合房角分离术治疗闭角型青光眼的临床效果。

方法：回顾性分析合并有白内障的闭角型青光眼患者,且房角关闭粘连范围≤180°的患者46例56眼,行白内障超声乳化吸出+人工晶状体植入联合房角分离手术,观察分析术前和术后眼压、视力、前房深度、前房角的变化。

结果：术后眼压全部控制在21mmHg(1mmHg=0.133kPa)以下,最佳矫正视力均有不同程度的提高,前房深度明显增加,房角均有不同程度开放。术中、术后无严重手术并发症。术前和术后眼压、前房深度、最佳矫正视力差异有统计学意义(P<0.05)。

结论：选择对合适的闭角型青光眼合并白内障的患者施行白内障超声乳化联合房角分离手术能够获得满意的临床效果。     

超声乳化治疗特殊类型白内障技术分析

目的：探讨超声乳化术治疗特殊类型白内障的安全性和有效性。

方法：回顾性分析临床资料,研究超声乳化吸出(联合)人工晶状体植入术治疗青光眼术后白内障、小瞳孔白内障、葡萄膜炎并发白内障和外伤后并发白内障等特殊类型白内障的技术要领。

结果：进行治疗的73例84眼特殊类型白内障患者中,单纯行超声乳化术27例28眼,植入后房型人工晶状体52眼,植入前房型人工晶状体4眼; 术后1mo平均眼压12.72±2.63mmHg,脱盲率99%,脱残率96%; 并发症发生率4%。

结论：特殊类型白内障手术难度大,超声乳化术切口小,可保留晶状体后囊膜和植入人工晶状体,是摘除特殊类型白内障的理想术式。     

Intraocular contamination during cataract surgery according to surgical technique and type of implant]

PURPOSE: To determine wether the cataract extraction method and intraocular lens material affect bacterial contamination of the eye during surgery. METHODS: This retrospective study evaluated microbial contamination of the anterior chamber fluid in three group of patients. Group 1: extracapsular extraction and PMMA lens (354 cases). Group 2: phacoemulsification and PMMA lens (474 cases). Group 3: phacoemulsification and silicone lens with PMMA haptic (264 cases). RESULTS: Microbial contamination rate was in group 1: 5.65%, in group 2: 4.75%, and in group 3: 4.54%. The difference was not statistically significant (chi: 0.321). All contaminants were Gram positive. CONCLUSION: Bacterial contamination rate of the anterior chamber is similar during extracapsular extraction and phacoemulsification, and is not modified when using PMMA or silicone lens.     

超声乳化术治疗闭角型青光眼合并白内障的疗效

目的:评估超声乳化手术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)的临床效果及预后影响因素。方法:对合并PACG白内障的患者60例70眼,其中急性PACG43眼,慢性PACG27眼。采用超声乳化白内障摘出联合折叠式人工晶状体植入手术治疗,手术前后观察视力、眼压、房角镜检查、前房深度等。术后随访6mo。结果:手术前后比较:视力提高(P<0.05);平均眼压下降(P<0.01);房角不同程度开放(P<0.01);前房深度增加(P<0.01)。手术成功率:急性PACG组高于慢性PACG组,差异有统计学意义(P<0.05)。结论:超声乳化手术对急性PACG治疗效果优于慢性PACG,慢性期及慢性PACG治疗效果差。     

Intraocular bacterial contamination during sutureless, small incision, single-port phacoemulsification

PURPOSE: To evaluate the incidence of anterior chamber bacterial contamination during no-stitch, 1-handed, small incision phacoemulsification. SETTING: Little Company of Mary Hospital, Evergreen Park, Illinois, USA. METHODS: This study comprised 53 eyes of 46 patients. Topical gentamicin sulfate was administered 1 hour preoperatively. After povidone-iodine cleansing solution and povidone-iodine paint (5% and 10%) were applied, the eyes were draped in a sterile manner. Aqueous fluid was aspirated upon entering the anterior chamber and at the end of surgery; the specimens were cultured for up to 14 days. All eyes had no-stitch, 1-handed, small incision phacoemulsification with implantation of a foldable acrylic posterior chamber intraocular lens through a 3.5 mm scleral tunnel incision. RESULTS: Three specimens (5.7%) aspirated on entry into the anterior chamber were positive for microorganisms. Of the cultures obtained at the end of surgery, 4 (7.5%) were positive for microorganisms. All posterior lens capsules were intact. The following organisms were cultured at the end of phacoemulsification: alpha-streptococci, micrococci, saprophytic mold, alpha-viridans streptococci, coagulase-negative Staphylococcus species, and anaerobic positive cocci. No eye developed endophthalmitis. CONCLUSIONS: The incidence of anterior chamber bacterial contamination was low. Bacterial contamination of the anterior chamber occurred at the beginning and toward the end of phacoemulsification. Staphylococcus species was the most common organism in the beginning, while Streptococcus species was the most common at the end. Saprophytic mold was present only at the end. No eye developed endophthalmitis.