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.     

低浓度聚维酮碘降低结膜囊细菌量的有效性分析

目的:探讨1,5,25g/L三种不同浓度聚维酮碘清除结膜囊细菌的效果及其副作用。方法:采用随机对照性研究方法,选择2009-09/10在武汉爱尔眼科医院行白内障手术的患者205例205眼,用随机数字法分为3组。手术前1d,用3g/L氧氟沙星眼液滴患眼3次。术前约5～10min左右,表面麻醉后依照不同分组分别用1,5,25g/L三种不同浓度聚维酮碘冲洗结膜囊。在下列时间点采集患者结膜囊标本做细菌培养和药物敏感性试验:入院时未用任何药物之前的基准培养;使用1d的3g/L氧氟沙星滴眼液后,未冲洗结膜囊前;聚维酮碘冲洗结膜囊约5～10min后,手术刚开始时;手术结束时。各组间培养阳性率的比较,采用Pearson卡方检验。并注意观察使用聚维酮碘后眼部的不良反应。结果:未用药前,1g/L聚维酮碘组、5g/L聚维酮碘组及25g/L聚维酮碘组结膜囊细菌培养阳性率分别为63.0%,61.4%及59.6%;手术完成后,3组结膜囊培养阳性率分别为12.3%,11.4%及12.9%,各组在用药前与手术结束时的阳性率差别均有显著的统计学意义(χ2值分别为54.88,57.61,40.47,P值均为0)。但是无论是用药前,还是在手术结束时,三组间培养阳性率的差别均无统计学意义(未用药前χ2=0.15,P=0.92;手术结束时χ2=0.06,P=0.96)。62例使用25g/L聚维酮碘患者有4例患者出现结膜充血和轻度角膜水肿,占6%,无其他不良反应,其他2组没有发现明显不良反应,三组间差别有显著的统计学意义(χ2=9.4,P=0.009)。结论:术前使用1g/L低浓度聚维酮碘冲洗结膜囊可以有效清除眼表细菌,和使用25g/L高浓度聚维酮碘的效果相似,而且更为安全。     

庆大霉素和聚维酮碘对结膜囊细菌清除率的比较研究

目的 探讨庆大霉素、0.5%聚维酮碘及5.0%聚维酮碘清除结膜囊细菌的效果及其副作用.方法 采用比较性研究,选择2006年3月至5月在武汉爱尔眼科医院行眼前节手术的300例患者(300只眼),采用随机数字法分为3组.手术前1 d,用0.3%氧氟沙星眼液滴患眼6次.表面麻醉后术前约5 min依照不同分组分别用0.8%庆大霉素注射液、0.5%聚维酮碘及5.0%聚维酮碘冲洗结膜囊.在下列时间采集患者结膜囊标本做细菌培养和药物敏感性试验:入院时未用任何药物之前的基准培养;使用0.3%氧氟沙星滴眼液1 d后;未用药物冲洗结膜囊前;手术刚开始时;冲洗结膜囊约5 min后;手术结束时.在手术开始时,采集前房水标本做细菌培养.各组间培养阳性率的比较,采用Pearson卡方检验.结果 未用药前,0.8%庆大霉素注射液组、0.5%聚维酮碘组及5.0%聚维酮碘组结膜囊培养阳性率分别为79.7%、76.6%及77.8%,差异无统计学意义(X2=0.28,P=0.86);手术完成后,3组结膜囊培养阳性率分别为11.7%、8.3%及6.3%,差异也无统计学意义(X2=1.74,P=0.41).前房水培养平均阳性率为4.9%,3组之间比较差异无统计学意义(X2=1.21,P=0.54).患者未出现对聚维酮碘有明显的不良反应.结论 表面麻醉后术眼结膜囊内使用0.5%国产聚维酮碘和5.0%进口聚维酮碘均较安全;术前用0.8%庆大霉素注射液、0.5%聚维酮碘及5.0%聚维酮碘冲洗结膜囊清除眼表细菌的效果相似.     

Three-day application of topical ofloxacin reduces the contamination rate of microsurgical knives in cataract surgery: a prospective randomized study

PURPOSE: To determine the rate of contamination of microsurgical knives during cataract surgery and the benefit of a 3-day versus a 1-hour preoperative application of topical ofloxacin in reducing the contamination rate. DESIGN: Prospective, randomized controlled trial. PARTICIPANTS: Seventy-eight eyes of 75 patients were randomly assigned to control (39 eyes) or study groups (39 eyes). METHODS: All patients from both groups received 0.3% topical ofloxacin 1 hour before surgery, 5% povidone-iodine (PVI) scrub of the periorbital area, and 2 drops of PVI onto the ocular surface preoperatively. The patients in the study group also received ofloxacin 4 times a day for 3 days before surgery. MAIN OUTCOME MEASURES: Microsurgical knives were placed in blood culture broth media immediately after the incision had been made. The number of positive cultures and types of bacteria isolated were determined. RESULTS: Ten of 39 knives (26%) in the control group were found to be positive for bacterial growth compared with only 2 of 39 (5%) in the study group (P = 0.028). CONCLUSIONS: The initial paracentesis incision frequently results in contamination of the microsurgical knife and may serve as a mechanism for introducing bacteria from the ocular surface into the anterior chamber. The application of topical ofloxacin for 3 days before surgery significantly reduces the contamination rate of the microsurgical knives, compared with a preoperative application of ofloxacin given 1 hour before surgery.     

莫西沙星对减少结膜囊细菌效果的临床实验研究

目的 探讨术前应用0.5%莫西沙星眼药水对减少结膜囊细菌的效果.方法 对96例(98只眼)行眼前节手术的患者,随机分为A、B两组,分别于术前3 d和1 d用0.5%莫西沙星眼药水点眼,用药及手术前后取结膜囊标本做肉汤培养基培养、血平板培养及厌氧菌培养,对阳性结果行药物敏感性试验.结果 肉汤培养结果示:用药3 d或1 d后(T1)A、B两组的结膜囊细菌阳性率均低于用药前(P=0.000),术前1 h用药及聚维酮碘冲洗结膜囊后(T2),A、B两组的阳性率均低于T1(P=0.005;P=0.016),手术完成时(T3)A、B两组的阳性率与T2无差异(P=0.399;P=0.140),在各个时间点,A、B两组之间结膜囊细菌培养阳性率均差异无统计学意义(P＞0.05).血平板培养结果示:用药后(T1)两组结膜囊细菌阳性率均明显下降(P＜0.001),CFUs＞10的菌株消失.厌氧菌培养结果示:用药后(T1)两组结膜囊细菌阳性率无明显下降(P＞0.05).结论 术前1 d局部应用0.5%莫西沙星眼药水可以明显减少结膜囊需氧菌.     

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。     

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.     

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。     

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.     

Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery

PURPOSE: To determine the efficacy of reducing conjunctival bacterial flora with topical ofloxacin when given for 3 days compared with 1 hour before surgery. DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS: Ninety-two eyes from 89 patients were randomized to a control group (48 eyes) or study group (44 eyes). METHODS: All patients from both groups received topical ofloxacin 0.3% 1 hour before surgery and a 5% povidone iodine scrub of the periorbital area before surgery. The patients in the study group received additional ofloxacin four times daily for 3 days before surgery. MAIN OUTCOME MEASURES: Conjunctival cultures were obtained at five separate time points and were inoculated in solid and liquid culture media. The presence of bacteria was determined, quantified, and identified. RESULTS: Forty-two percent of eyes in the control group had positive conjunctival culture immediately before surgery, compared with 19% of eyes in the study group (P < 0.05). Immediately after surgery, 34% and 14% of eyes had positive cultures in the control and study groups, respectively (P < 0.05). Quantitatively, fewer bacteria were isolated from eyes in the study group compared with those in the control group for culture samples that were obtained both before povidone iodine scrub and at the conclusion of surgery (P 相似文献   

Comparison of preoperative conjunctival bacterial flora in patients undergoing glaucoma or cataract surgery

PURPOSE: To assess differences in conjunctival bacterial flora between patients undergoing glaucoma and cataract surgery. PATIENTS AND METHODS: A prospective study comparing conjunctival bacterial cultures obtained from 339 patients undergoing either cataract (n = 258) or glaucoma (n = 81) surgery. All cultures were acquired during the preoperative visit, approximately three to seven days prior to surgery. The culture samples were inoculated onto blood and chocolate agar, as well as blood culture broth media. All bacterial isolates were identified and statistical analyses were performed to determine if there were differences in flora between the eyes undergoing cataract versus glaucoma surgery. RESULTS: Two hundred fifteen of 258 eyes (83%) undergoing cataract surgery were found to have positive bacterial growth, compared with 62 of 81 eyes (77%) of those undergoing glaucoma surgery (P = 0.2246). Coagulase-negative Staphylococci, the most common bacterial isolate, was cultured from 167 eyes (65%) in the cataract group and 42 (52%) in the glaucoma group (P = 0.0514). Among all bacterial isolates, only Corynebacterium species was found to be statistically different between the two patient groups with 92 (36%) and 11 (14%) eyes testing positive in the cataract and glaucoma groups, respectively (P = 0.0003). CONCLUSIONS: There was no statistically significant difference in the proportion of conjunctival culture samples testing positive for bacterial growth in eyes undergoing glaucoma surgery compared with those undergoing cataract surgery. Glaucoma medications, or their preservatives, do not appear to significantly alter conjunctival flora. Techniques used for endophthalmitis prophylaxis prior to cataract surgery are likely appropriate for glaucoma surgery as well.     

不同浓度聚维酮碘的抗菌能力及对眼表的影响

目的　通过眼表综合分析仪和结膜囊细菌培养阳性率评估玻璃体内注药术（IVI）术前应用不同浓度（5.0 g·L^-1、2.5 g·L^-1）聚维酮碘（PVI）消毒结膜囊不同时间（3 min、1 min）对眼表组织和结膜囊抗菌能力的影响。方法　前瞻性研究。选取IVI注射雷珠单抗注射液患者60例（60眼）,术前根据PVI浓度及作用时间随机分为A组（5.0 g·L^-1,3 min）、B组（5.0 g·L^-1,1 min）、C组（2.5 g·L^-1,3 min）、D组（2.5 g·L^-1,1 min）,每组15例。应用Oculus Keratograph 5M眼表分析仪检测术眼术前及术后1 d、7 d、30 d下睑中央泪河高度（TMH）、非侵袭式首次泪膜破裂时间（NITBUTf）、非侵袭式泪膜平均破裂时间（NITBUTavg）、眼红指数和角膜荧光素染色 (CFS)评分,分析PVI消毒结膜囊前后眼表的情况,进而评估PVI对眼表组织的影响;分别在PVI消毒结膜囊前后采集标本,分析比较结膜囊细菌培养阳性率。结果　本研究入组患者年龄为(64.20±9.67)岁。A组、B组患者术后1 d TMH、 NITBUTf、NITBUTavg及A组患者术后7 d NITBUTavg均显著低于术前(均为P<0.05),于术后7~30 d恢复至术前水平。C组患者术后1 d TMH、 NITBUTf及D组患者术后1 d TMH均显著低于术前(均为P<0.05),于术后7 d恢复至术前水平。B组、C组患者术后7 d,D组患者术后30 d鼻侧睫状眼红指数均低于术前,差异均有统计学意义（均为P<0.05）。B组患者术后7 d、30 d,D组患者术后7 d及30 d鼻侧结膜眼红指数均低于术前,差异均有统计学意义（均为P<0.05）。A组患者术后1 d颞侧结膜眼红指数高于术前,差异有统计学意义（P<0.05)。A组、B组、C组患者术后 1 d、7 d CFS评分均高于术前（均为P<0.05）,术后30 d恢复至术前水平;D组患者术后 1 d CFS评分高于术前（P<0.05）,术后7 d恢复至术前水平。患者术眼结膜囊经PVI消毒后细菌培养阳性率均为0.0%。结论　低浓度短时间（2.5 g·L^-1,1 min）PVI消毒结膜囊在减少中老年患者眼表损伤的同时可抑制结膜囊细菌量,有效预防眼内炎。     

白内障术前应用不同浓度聚维酮碘的疗效观察

目的：比较白内障术前应用不同浓度聚维酮碘(PI)在结膜囊作用不同时间,观察PI的消毒效果,以及对结膜囊菌群、眼表的影响,筛选PI的最佳浓度和作用时间。

方法：本研究为前瞻性研究,选择2015-06/2017-06于我院行白内障手术患者270例270眼,根据用药浓度(5、1、0.5g/L)随机分为三组,每组90眼。根据不同作用时间(30s,1、2min)进一步随机分配各个亚组,每亚组各30眼。患者按分组情况进行术前PI结膜囊冲洗,并于冲洗前后进行结膜囊细菌样本采集,比较PI冲洗前后结膜囊细菌菌群变化和细菌培养阳性情况。同时比较术前3d与术后1、3d,1wk,1、3mo的泪膜破裂时间(BUT)、角膜荧光素染色(CFS)变化,观察PI冲洗结膜囊对眼表的影响。

结果：(1)结膜囊菌群变化：PI冲洗前结膜囊细菌培养共12种,其中革兰氏阳性菌9种,革兰氏阴性菌3种; PI冲洗后结膜囊细菌培养共4种,其中革兰氏阳性菌2种,革兰氏阴性菌2种。(2)结膜囊细菌培养阳性情况的比较：PI冲洗前结膜囊细菌培养阳性15眼,冲洗后细菌培养阳性5眼,PI冲洗前后细菌培养阳性眼数减少(P<0.05)。(3)安全性：所有患者术后末次随访,术眼均未发生眼内炎,除0.5g/L、30s组及5g/L、2min组外的所有组别,BUT均在术后3mo恢复术前水平。0.5g/L、30s组BUT术后1mo就恢复到术前水平,5g/L、2min组BUT至术后3mo仍未恢复至术前; 所有组别CFS均在术后1mo恢复至术前水平。

结论：0.5g/L PI结膜囊冲洗30s能有效减少结膜囊细菌,较其他作用时间和浓度组对眼表的损伤更小,用于白内障术前结膜囊消毒是安全有效的。     

The effect of topical povidone-iodine, intraocular vancomycin, or both on aqueous humor cultures at the time of cataract surgery

PURPOSE: To investigate whether the use of topical povidone-iodine before surgery, the addition of vancomycin to the irrigating solutions during phacoemulsification, or both reduces the frequency of positive intraocular cultures at the end of surgery. METHODS: A two-part, clinical study was performed. In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 11 eyes) and 2 hours after surgery (in 11 eyes) in patients treated with vancomycin. In the primary study, 400(1) patients were divided into four groups composed of 100 eyes each. The first and the second groups received vancomycin (20 microg/ml) in the irrigating fluid. The third and the fourth groups received irrigating fluid only without antibiotics. The first and third groups received a topical 5% povidone-iodine solution 10 and 5 minutes before surgery; a topical placebo solution was used in the second and the fourth groups. All patients in the primary study underwent anterior chamber aspiration after surgery, and culturing was performed 2 hours later. Identification and quantification of positive cultures in thioglycolate broth and chocolate agar were performed. RESULTS: In the preliminary study, the half-life of intraocular vancomycin was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in two (2%), five (5%), 11 (11%), and 13 (13%) specimens from the first, second, third, and fourth groups, respectively. CONCLUSIONS: We found a lower rate of positive cultures in the group that received vancomycin in the irrigating fluid; 2 hours of contact between the antibiotic solution and bacteria produced results that reached statistical significance (P = 0.032).     

Effects of povidone-iodine chemical preparation and saline irrigation on the perilimbal flora.

PURPOSE: To analyze the effects of 5% povidone-iodine preparation and saline irrigation on the species composition of perilimbal flora. METHODS: Cultures were taken from the perilimbal conjunctiva in 100 eyes before preparation for ophthalmic surgery, after instillation of povidone-iodine solution, and after saline irrigation. RESULTS: Bacteria were isolated in 75% of eyes before preparation, in 28% after povidone-iodine instillation, and in 24% after saline irrigation. Fifty-one culture-positive eyes became negative with povidone-iodine, while only four culture-negative eyes became culture-positive (P < 0.001). The number of eyes yielding coagulase-negative staphylococci, Staphylococcus aureus, and Propionibacterium were significantly decreased after povidone-iodine instillation. Twenty-three culture-positive eyes became negative after saline irrigation, while 19 culture-negative eyes became culture-positive (P > 0.25). CONCLUSION: Povidone-iodine solution is effective in reducing bacterial recovery from the perilimbal conjunctiva, where most incisions for intraocular surgery occur. Saline irrigation after povidone-iodine preparation has no significant effect.     

飞秒激光小切口透镜取出术围手术期加替沙星眼用凝胶细菌清除率研究 △

目的 探讨加替沙星眼用凝胶在飞秒激光小切口基质透镜取出术(SMILE)围手术期预防性使用的有效性与安全性。方法 选择行SMILE的患者181例(181眼),随机分为2组,A组90例,B组91例。A组和B组在术前分别滴用0.3%加替沙星眼用凝胶和0.5%左氧氟沙星滴眼液,用药前后进行结膜囊细菌培养及药敏试验。结果 SMILE前结膜囊细菌培养阳性率为11.60%,其中表皮葡萄球菌15例、微球菌2例、唾液链球菌1例、微小棒状杆菌2例、铜绿假单胞菌1例。A组和B组用药前结膜囊细菌培养阳性率分别为10.00%和13.19%(P>0.05), 用药后细菌清除率均为100%。所有患者均未发现明显的不良反应。结论 SMILE前滴用加替沙星眼用凝胶和左氧氟沙星滴眼液的细菌清除率效果相似。     

聚维酮碘二次消毒对结膜囊细菌的杀灭作用

目的 探讨聚维酮碘二次消毒对结膜囊细菌的清除效果.方法 采取比较性研究,选择在我院行白内障超声乳化手术的259例（259只眼）患者,随机分为4组.各组分别在以下时间点采集结膜囊标本做细菌培养和药物敏感性试验：A组：未使用任何药物之前的基准培养;B组：使用左氧氟沙星滴眼液（商品名：可乐必妥）1 d后;C组：术前手术区皮肤及结膜囊第1次聚维酮碘消毒后;D组：0.05%聚维酮碘消毒液（0.5%聚维酮碘原液10倍稀释）再次冲洗结膜囊后.采用卡方检验进行各组间培养阳性率的比较.结果 A、B、C、D四组的结膜囊培养阳性率分别是 96%、28.6%、3.77%、0%.应用SPSS数据分析软件对数据两两比较结果差异均有统计学意义（P＜0.05 ）.结论 术前抗生素预防用药以及在术前常规消毒后再进行二次结膜囊冲洗消毒有助于结膜囊细菌的彻底清除.     

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.     

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.     

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.