内眼手术前,后结膜囊细菌学研究

目的:探索眼科内眼手术前后结膜囊细菌学变化特点及临床眼科用药效果。方法:133眼需要行内眼手术的连续病例包括白内障手术68眼、青光眼手术39眼、视网膜脱离手术20眼、玻璃体切割术6眼。用133眼内眼手术病人手术前后的结膜刮片及68眼白内障手术术毕的前房冲洗液作细菌培养,并作药敏试验。结果:133眼内眼手术患者入院时结膜刮片作细菌培养有61眼(45.85％)培养出细菌,其中金黄色葡萄球菌23眼、表皮葡萄球菌25眼、G~ 杆菌13眼;手术消毒前结膜囊刮片有8眼(6％)仍培养出细菌,其中金黄色葡萄球菌3眼,表皮葡萄球菌5眼;68眼白内障手术患者前房冲洗液中仅1眼(1.5％)培养出细菌,为表皮葡萄球菌;术毕时结膜刮片4眼(3％)培养出细菌,所培养出来的细菌均对妥布霉素、庆大霉素、先锋Ⅵ、万古霉素和利福平敏感,而对四环素、氯霉素、红霉素、氧氟沙星耐药。结论:肉眼手术前应用有效抗菌素至为重要,可预防眼内炎的发生,但不可轻视手术无菌操作。眼科学报1999;15:267-269。

Study on Bacterial Strains in Conjunctival Sac before and after Intraocular Surgery

Purpose: To investigate the changes of bacterial strains in the conjunctival sac before and after intraocular surgery, as well as clinical effects of preoperative antibiotic agents. Methods ? One hundred and thirty-three eyes with intraocular surgery included 68 eyes with cataract surgery, 39 eyes with glaucoma surgery, 20 eyes with retinal detachment surgery and 6 eyes with vitretomy. Bacterial culture and pharmacologic sensitivity test were performed on the conjunctival smear from the 133 eyes with intraocular surgery before and after the operation and the anterior chamber aspirate from the 68 eyes with cataract surgery after the operation.Results: At the time of admission, 61 eyes(45. 8% ) of 133 eyes with intraocular surgery were culture-positive conjunctival smears with the following identified: Staphlococ-cus aureus: 23 eyes; Staphlococcus epidermidis: 25 eyes; Gram-positive rods: 13 eyes. 8 eyes (6% ) had culture-positive conjunctival smears before disinfetion, (Staphlococcus aureus: 3 eyes; Staphlococcus epidermidis: 5 eyes) . One eye(1. 5% ) had culture-positive Staphylococcus epidermidis in anterior chamber aspirate of 68 eyes with cataract surgery at conclusion of surgery. Also, 4 eyes(3% ) were culture-positive conjunctival smears after surgery. All the bacterial strains of the group were sensitive to Tobramycin, Gentamycin, Cephradinum(Velosel) , Vancomycinum and Rifampin, but they were resistance to Tetracyclinum, Chloromycetin, Erythromycin and Ofloxacin. Eye Science 1999; 15: 267-269.Conclusion: In order to prevent bacterial endophthalmitis after intraocular surgery, installation of an useful antibiotic eye drop before the surgery is important