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。     

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.     

Lens epithelial cells in postoperative aqueous humor

The aqueous humor during or after cataract surgery often contains red blood cells (RBCs) from blood; inflammatory cells from white blood cells (WBCs); fibrin, pigment cells, and fibroblasts from either the iris or the ciliary body; lens epithelial cells (LECs); and corneal endothelial cells. Since LECs may be related to postoperative complications, including a fibrin reaction and a secondary cataract, confirmation of their presence postoperatively not only in the capsular bag, but also in the aqueous humor, is necessary for identifying these complications. Using aqueous humor obtained from pig eyes, I attempted to identify LECs immunohistochemically in the aqueous humor, following phacoemulsification (PEA) and aspiration of the cortex, and found the presence of cells that react to keratin antibody, the marker for epithelial cells. Although these cells could be lens, conjunctival, or corneal epithelial cells, they were found following PEA and aspiration of the cortex, and therefore are believed to be LECs.     

Comparison of different endophthalmitis prophylactic measures in cataract surgery - An analysis of 2.4 lakh cases

Purpose:To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes.Methods:All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated.Results:70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006).Conclusion:There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.     

前房放液治疗白内障超声乳化吸出术后早期高眼压

目的探讨前房放液治疗白内障超声乳化吸出及人工晶状体植入术后早期高眼压合并角膜上皮水肿的可行性。方法白内障超声乳化吸出及人工晶状体植入术1572眼中31眼术后早期高眼压合并角膜上皮水肿,平均眼压46mmHg(1kPa=7.5mmHg),前房放液在裂隙灯显微镜下进行,镊子轻压上方切口后缘,缓慢放出少量房水,即可见角膜上皮水肿明显减轻或消失。结果29眼1次放液后眼压未再升高,角膜上皮水肿消失,其余2眼为后囊膜破裂患者,1眼术后第1d、2d2次放液后眼压恢复正常,1眼术后第1d、2d2次放液联合降眼压药物治疗,于术后5d眼压恢复正常。结论前房放液是治疗白内障术后早期高眼压合并角膜上皮水肿的理想方法。     

超声乳化白内障摘除术后眼内炎的临床探讨

目的:探讨超声乳化白内障摘除术后眼内炎的发生,预防和治疗方法。方法:对2001/2007间行超声乳化白内障摘除人工晶状体植入术的15615眼进行回顾性分析。结果:全部术眼中有9例术后发生眼内炎。均于发现后立即行玻璃体切割玻璃体注药术,并做玻璃体细菌学检查,3眼细菌培养阳性,1眼证实为真菌感染。2眼治疗后无光感,1眼眼球摘除。结论:超声乳化摘除术后眼内炎的发生率为0.058%,危险因素主要为结膜囊的污染和后囊膜破裂。术前严格消毒,减少后囊膜破裂的发生,同时积极地治疗可控制其发生和发展。     

白内障超声乳化292例(315眼)手术并发症分析

目的 评价白内障超声乳化手术的疗效。方法 通过对２９２例白内障超声乳化手术并发症进行分析。结果 术后第１天视力≥０．８者占３２．３８％,第３天时为１．４１％,后囊破裂占８．２２％,角膜浑浊占５．１４％。角膜内皮功能失代偿占０．６８％。结论手术的主要并发症为后囊破裂,较严重的并发症为角膜浑浊,损害最大者为眼内炎。     

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.     

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.     

Factors influencing treatment results in pseudophakic endophthalmitis

PURPOSE: To evaluate risk factors, therapeutic approaches and factors associated with the poor visual outcome in pseudophakic endophthalmitis. METHODS: Data related to 28 cases with the diagnosis of endophthalmitis after cataract surgery and IOL implantation were gathered retrospectively. RESULTS: Preceding surgery was extracapsular cataract extraction (ECCE) in 18, phacoemulsification in 8 and scleral fixated intraocular lens implantation in two cases. Posterior capsule rupture and diabetes mellitus were considered to contribute to the development of endophthalmitis because of their high incidences (50% and 25%) in the study group. Microbiological studies from aqueous and vitreous humour were done in 85% of the cases and 58% were positive. S. Epidermidis was the most common organism, accounting for 50% of the isolates. All cases were given topical and systemic antibiotics. Inflammation was controlled by addition of subconjunctival antibiotics to this regimen in two, intravitreal antibiotic injection in 14, pars plana vitrectomy, total capsular and lens extraction and intravitreal antibiotic injection in three, lens exchange, intracapsular and intravitreal antibiotic injection in three cases. Six (21%) cases eventually needed evisceration. Visual acuity of 20/40 or better was achieved in 25%, and 20/100 or better in 64%. CONCLUSIONS: Treatment delay (p=0.039), capsular rupture complicating cataract surgery, especially with extracapsular cataract extraction (p=0.015), and initial visual acuity worse than hand motion (p=0.003) were strong predictors of poor visual outcome. The risk of endophthalmitis was not different forplanned ECCCE (0.26%) andphacoemulsification (0.27%) but the prognosis was better with the latter.     

The effect of partial vitrectomy on blood-ocular barrier function in the rabbit

PURPOSE: To compare ocular vascular permeability in the rabbit after vitrectomy as assessed by contrast-enhanced magnetic imaging (CE-MRI) and measurements of aqueous and vitreous humor protein concentration. METHODS: Partial vitrectomies were performed, irrigating with BSS or BSS PLUS. Post-operative vascular leakage was determined by CE-MRI following intravenous administration of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Aqueous and vitreous protein concentrations were quantified by standard biochemical assay. ERG evaluations were performed on postoperative days 1, 3, and 7. RESULTS: Using BSS as irrigant, breakdown of the inner blood-retinal barrier (BRB) occurred in 4/7 eyes on post-operative day 1. The rate of Gd-DTPA leakage was significantly greater on postoperative day 1 than that in unoperated, control eyes, but declined approximately 50% by day 3. At both time points, outer BRB breakdown was restricted to the sclerotomy wounds. No BRB leakage was detectable in control eyes. Blood-aqueous barrier (BAB) leakage was bilateral on day 1. Significantly greater Gd-DTPA leakage occurred in the operated eye than in the nonsurgical contralateral eye. On day 3, approximately 40% bilateral reduction in leakage indicated resolution of BAB leakage. Notably, Gd-DTPA leakage of the BAB and BRB was significantly reduced in the BSS PLUS treated group. In contrast to MRI assessments, protein concentrations of the aqueous and vitreous in the surgical eye showed no detectable differences between BSS and BSS PLUS. Concurrent with the transient loss of ocular barrier function, ERG responses also declined. However, by day 7 greater than 90% recovery was noted in BSS PLUS treated animals but not in the BSS treatment group. CONCLUSIONS: CE-MRI is capable of detecting subtle changes in vascular permeability following ocular surgery. Advantages of using BSS PLUS compared to BSS as the irrigating solution can be detected using this technique. BSS PLUS's protection of barrier function is consistent with a rapid recovery in retinal function not observed in BSS treated eyes.     

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。     

Efficacy of intraoperative vancomycin in irrigating solutions on aqueous contamination during phacoemulsification

PURPOSE: To study the efficacy of adding vancomycin in irrigating solutions, in comparison to topical antibiotic given preoperatively for a day, during phacoemulsification, in reducing the anterior chamber (AC) contamination. SETTINGS AND DESIGN: This was a prospective, interventional, hospital-based study. MATERIALS AND METHODS: This was a study involving 400 eyes of 400 paitens, undergoing routine phacoemulsification between January 2004 and June 2006. The patients were non-randomly assigned to two groups: Group 1 included 180 patients, who received topical ciprofloxacin eye-drops (four-hourly) for a day preoperatively and Group 2 included 220 patients, who underwent phacoemulsification with vancomycin (20 microg/ml) in the irrigating solution. Anterior chamber aspirate obtained at the end of the surgery was sent for microbial workup. The number of positive cultures in both the groups was determined. STATISTICAL ANALYSIS: This was performed using Chi-square test. Results: Aqueous samples showed microbial growth in 38 (21.1%) out of 180 eyes in Group 1 and in 17 (7.7%) out of 220 eyes in Group 2 ( P = 0.001). Coagulase-negative staphylococcus was the most common organism in both the groups. Aqueous samples from four eyes in group 1 showed multiple organisms, while none of the sample from group 2 showed more than one organism. None of the eyes in either group showed fungal contamination. One patient in Group 1 developed endophthalmitis, and the causative organism was Alcaligenes faecalis. All patients were followed up for a minimum of six months (range: 6 to 14 months and mean: 9.3 months). CONCLUSION: Addition of vancomycin in irrigating solutions is more efficacious in reducing AC contamination in comparison to topical antibiotic administered a day preoperatively.     

Assessment of nitric oxide level in aqueous humor under physiological conditions and after lens extraction and artificial foldable acrylic lens implantation during experimental work in rabbits

PURPOSE: To evaluate the presence of nitric oxide (NO) and its level in the aqueous humor of rabbit's eye physiological conditions and after phacoemulsification and acrylic foldable artificial lens implantation. We also investigated nitric oxide maintenance during early postoperative period (between 1-5 days after surgery). MATERIAL AND METHODS: We examined 30 rabbits (weighing 3.0-3.5 kg) Just before surgery samples of aqueous humor were aspirated. Lens was extracted with phacoemulsification technique. In 15 eyes acrylic foldable IOL (group III) was implanted and 15 eyes were left aphakic (group IV). The aqueous samples were collected on 1, 3, 5 days after surgery. Nitric oxide in each sample was determined with fluorometric assay. RESULTS: The level of NO in aqueous humor in physiological conditions was estimated to 26.52 nM/dl. After phacoemulsification in both groups the level of nitric oxide was higher than in control group. The day and value of the highest NO level was different among examined groups. The highest level of NO was released during 1st day in group III and on the 3rd day in the group IV. CONCLUSION: We came to conclusion that the level of nitric oxide in aqueous humor after phacoemulsification in both groups is higher than in control group but significantly lower than in previously examined groups in which the surgery was made with extracapsular technique.     

Protective effect of free-radical scavengers on corneal endothelial damage in phacoemulsification

PURPOSE: To examine the role of the water-soluble antioxidants glutathione and ascorbic acid in the irrigating solution on corneal endothelial cells following exposure to high-intensity ultrasound energy. SETTING: Goldschleger Eye Research Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel. METHODS: Thirty-two rabbit eyes were subjected to prolonged exposure to the phacoemulsification device in the anterior chamber. The eyes were divided into 4 groups that differed only in the composition of the irrigating solution applied to the eyes: balanced salt solution (BSS) BSS Plus BSS containing additional soluble components including glutathione, BSS with 10(-3) M of oxidized glutathione (GSSG), and BSS with 10(-2) M of ascorbic acid. Specular microscopy was performed preoperatively and 1 week after surgery. RESULTS: The BSS group exhibited the highest endothelial cell loss (19.3%), followed by the BSS Plus group (10.6%), the GSSG group (5.2%), and the ascorbic acid group (0.9%). An overall difference was found between the groups (F = 11.046, P<.0001), and all groups demonstrated a statistically significant difference from the control BSS group (P<.02, P = .001, and P<.0001, respectively). CONCLUSIONS: Damage to the cornea is largely due to the free radicals generated by high-intensity ultrasound energy during phacoemulsification. Adding the antioxidants ascorbic acid and GSSG to the irrigation solution significantly reduced the endothelial corneal cell damage. Ascorbic acid in the concentration of 10(-2) M had the highest protective effect; thus, it should be evaluated for clinical use.     

腺病毒载体介导的单纯疱疹病毒胸苷激酶／丙氧鸟苷系统抑制晶状体后囊膜混浊的研究

背景晶状体后囊膜混浊（PCO）目前尚无有效的防治途径。目的研究腺病毒载体介导的单纯疱疹病毒胸苷激酶（HSV-tk）／丙氧鸟苷（GCV）系统对PCO的抑制作用。方法选取新西兰白兔12只,用电脑随机选号法随机分为BSS＋BSS组、BSS＋GCV组、HSV-tk＋BSS组及HSV-tk＋GCV组,每组3只。兔眼行晶状体超声乳化摘出术,术中依据分组情况分别在晶状体囊袋中注入0．1mlBSS或携带有HSV-tk基因的腺病毒载体,术后12h分别在BSS＋BSS组和HSV-tk＋BSS组兔眼前房注入0．1mlBSS,BSS＋GCV组及HSV-tk＋GCV组以同样的方法注入GCV,每日1次,共3次。术后裂隙灯下观察眼前节情况,PCO分级按照Couderc的方法。术后4周摘除兔眼,采用Miyake-Apple法观察PCO情况,显微镜下取出晶状体囊袋后以电子天平称出整个囊袋湿质量,并行晶状体囊袋的组织学检查。结果术后1～3d各组均可见角膜轻度水肿与房水混浊,2周内基本恢复正常。术后4周,HSV-tk＋GCV组PCO明显轻于其他3组,差异均有统计学意义（H=2．647、H=2．939、H=2．884,P〈O．05）,而BSS＋BSS组、BSS＋GCV组、HSV-tk＋BSS组组间的差异均无统计学意义（H=0．631、H=0．924、H=0．589,P〉0．05）。Miyake-Apple法观察显示,HSV-tk＋GCV组PCO面积与密度小于其他3组,晶状体囊袋湿质量也明显轻于其他3组,差异均有统计学意义（q=9．93、q=10．15、q=10．07,P〈O．05）,BSS＋BSS组、BSS＋GCV组、HSV-tk＋BSS组组间差异均无统计学意义（q=0．22、q=0．07、q=015,P〉0．05）。囊袋组织学检查提示HSV-tk＋GCV组可见少量赤道部晶状体上皮细胞（LECs）增生并向后囊膜迁移,在囊袋外周形成稀薄的soemmering环,在中央部无细胞和皮质,或仅形成单细胞层纤维膜。BSS＋BSS组、BSS＋GCV组、HSV—tk＋BSS组可见大量赤道部LECs增生和迁移,在囊袋外周部soemmering环稠厚,在中央部形成多细胞层纤维膜。结论腺病毒载体介导的HSV-tk／GCV系统能有效抑制PCO。     

Experimental prophylaxis of Staphylococcus aureus endophthalmitis after vitrectomy: the use of antibiotics in irrigating solution.

PURPOSE: To test the efficacy of clindamycin and gentamicin in irrigating solution during vitrectomy to prevent experimental Staphylococcus aureus endophthalmitis. MATERIALS AND METHODS: Thirty-six New Zealand white rabbits were divided into six groups. Vitrectomy using two different irrigating solutions was followed by intravitreal injection of S. aureus: Group 1, balanced salt solution (BSS) followed by 1,000 colony-forming units (CFU) S. aureus; Group 2, BSS fortified with clindamycin, 10 microg/mL, and gentamicin, 8 microg/mL (CGBSS), followed by intravitreal injection of 1,000 CFU S. aureus; Group 3, BSS followed by 2,000 CFU S. aureus; Group 4, CGBSS followed by 2,000 CFU S. aureus; Group 5, BSS followed by 4,000 CFU S. aureus; and Group 6, CGBSS followed by 4,000 CFU S. aureus. The eyes were examined clinically after surgery. Vitreous samples were cultured and histologic studies were performed. RESULTS: Severe endophthalmitis developed in all eyes in Groups 1, 3, and 5 (not given antibiotics). No endophthalmitis developed in Group 2. In Group 4, five of the six eyes were normal and one eye had endophthalmitis. In Group 6, one eye had clear vitreous and fundus, three eyes had moderate vitreous haze, and the other four eyes demonstrated severe endophthalmitis. Bacterial growth in Groups 1, 2, 3, 4, 5, and 6 were 4/4, 0/4, 6/6, 1/6, 4/6, and 2/8 eyes, respectively. CONCLUSION: When 1,000 to 2,000 CFU S. aureus were injected after vitrectomy, clindamycin and gentamicin in the irrigating solution significantly diminished the intraocular inflammation and the rate of positive bacterial culture. Clindamycin and gentamicin in the irrigating solution were not significantly effective when 4,000 CFU bacteria was injected; however, the degree of inflammation was less severe than in the control group.     

Different techniques of extracapsular cataract extraction: bacterial contamination during surgery

This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.     

白内障摘除手术方式对兔眼房水中TNF-α、IL-1β、IL-6的影响

目的探讨不同白内障手术方式对兔眼房水中TNF-α、IL-1β和IL-6含量影响。方法 18只日本大耳白兔均分3组,I组空白对照组;II组超声乳化摘除术组;Ⅲ组超声乳化联合前段玻璃体切割术组。分别于术前,术后1、3、7、14、28 d对术眼进行临床检查,并抽取房水于-30℃中保存。用酶联免疫吸附试验对术后兔房水中的TNF-、IL-1β和IL-6含量进行测定。结果Ⅲ组后囊混浊程度较II组轻;兔房水TNF-α、IL-1β和IL-6含量于术后3、7、14 d和28 d明显升高,术后7～14 d达最高值;Ⅲ组房水中TNF-α、IL-1β和IL-6含量较II组的稍低,具有统计学意义。结论超声乳化联合前段玻璃体切割术治疗后发性白内障的效果优于单纯的超声乳化摘除术,在一定程度阻止后发障的发生。超声乳化联合前段玻璃体切割术后的TNF-α、IL-1β和IL-6的含量较单纯的超声乳化摘除术的低,TNF-α、IL-1β和IL-6可能参与后发性白内障的形成。     

老年性白内障患者血清及房水中SOD、MDA表达与后囊膜混浊的关系

目的　探究老年性白内障患者血清及房水中超氧化物歧化酶（SOD）、丙二醛（MDA）表达与后囊膜混浊的关系。方法　选取2017年5月至2021年4月我院收治的200例（200眼）老年性白内障患者作为观察组,另选取同期健康体检者60名（60眼）作为对照组。比较两组受检者血清及房水中SOD、MDA表达,并评价受检者血清及房水中SOD、MDA对老年性白内障的诊断价值,分析老年性白内障患者术后后囊膜混浊发病的影响因素。结果　观察组患者血清及房水中SOD表达均较对照组低,血清及房水中MDA表达均较对照组高（均为P<0.05）。血清及房水中SOD、MDA联合诊断老年性白内障的AUC最大,为0.914（95%CI:0.873～0.945）,敏感度为86.67%,特异度为82.00%。年龄,人工晶状体材料,血清及房水中SOD、MDA含量手术前后差值绝对值均为老年性白内障患者术后后囊膜混浊发生的独立影响因素（均为P<0.05）。结论　老年性白内障患者血清及房水中SOD、MDA含量均存在一定变化,检测其表达水平,可为疾病诊断及术后后囊膜混浊预测提供参考依据。