Abstract
AIMS--The study was designed to investigate the bacterial flora of the operating field during routine cataract surgery and the source of intraocular lens contamination during the surgery. METHODS--The normal flora of the external eye and fornices of 17 patients undergoing selective cataract surgery was determined preoperatively. Swabs taken from the eyelid surface and lashes showed coagulase negative staphylococci (CNS) in 90%, Propionibacterium acnes in 62%, Corynebacterium sp in 18%, and Peptostreptococcus in 3% of the patients. The lower fornices of 70% had CNS, 47% P acnes, 6% Staphylococcus aureus, 6% Corynebacterium sp, and 6% Candida. RESULTS--A sterile PMMA intraocular lens was touched on the upper bulbar conjunctiva immediately before the surgery. Eighty two per cent of lenses grew CNS, 18% P acnes, 18% Bacillus sp, 12% S aureus, and 6% Corynebacterium sp. A second sterile PMMA intraocular lens was left on the drape and near the eye during surgery. Forty seven per cent of these cultured CNS, 12% Corynebacterium sp, and 6% Bacillus sp. A high count of bacteria in the operating field, especially CNS and P acnes can contribute to postoperative inflammation and endophthalmitis. CONCLUSION--Special measures are needed before and during the surgery to reduce the chance of intraocular inoculation of these bacteria. Use of proper culture media and techniques are necessary to identify these organisms, especially anaerobes, in postoperative inflammation.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Apple D. J., Mamalis N., Steinmetz R. L., Loftfield K., Crandall A. S., Olson R. J. Phacoanaphylactic endophthalmitis associated with extracapsular cataract extraction and posterior chamber intraocular lens. Arch Ophthalmol. 1984 Oct;102(10):1528–1532. doi: 10.1001/archopht.1984.01040031248029. [DOI] [PubMed] [Google Scholar]
- Isenberg S., Apt L., Yoshimuri R. Chemical preparation of the eye in ophthalmic surgery. I. Effect of conjunctival irrigation. Arch Ophthalmol. 1983 May;101(5):761–763. doi: 10.1001/archopht.1983.01040010761012. [DOI] [PubMed] [Google Scholar]
- Jansen B., Hartmann C., Schumacher-Perdreau F., Peters G. Late onset endophthalmitis associated with intraocular lens: a case of molecularly proved S. epidermidis aetiology. Br J Ophthalmol. 1991 Jul;75(7):440–441. doi: 10.1136/bjo.75.7.440. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McNatt J., Allen S. D., Wilson L. A., Dowell V. R., Jr Anaerobic flora of the normal human conjunctival sac. Arch Ophthalmol. 1978 Aug;96(8):1448–1450. doi: 10.1001/archopht.1978.03910060196020. [DOI] [PubMed] [Google Scholar]
- Meisler D. M., Mandelbaum S. Propionibacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology. 1989 Jan;96(1):54–61. doi: 10.1016/s0161-6420(89)32939-3. [DOI] [PubMed] [Google Scholar]
- Meltzer D. W. Sterile hypopyon following intraocular lens surgery. Arch Ophthalmol. 1980 Jan;98(1):100–104. doi: 10.1001/archopht.1980.01020030102008. [DOI] [PubMed] [Google Scholar]
- Roussel T. J., Culbertson W. W., Jaffe N. S. Chronic postoperative endophthalmitis associated with Propionibacterium acnes. Arch Ophthalmol. 1987 Sep;105(9):1199–1201. doi: 10.1001/archopht.1987.01060090057026. [DOI] [PubMed] [Google Scholar]
- Spencer S. R., Dealler S. F., Hassett P. D., Todd N. J., Hawkey P. M., Noble B. A. Bacterial contamination of intraocular lenses: the source of the bacteria. Eye (Lond) 1989;3(Pt 6):685–689. doi: 10.1038/eye.1989.105. [DOI] [PubMed] [Google Scholar]
- Stern G. A., Engel H. M., Driebe W. T., Jr Recurrent postoperative endophthalmitis. Cornea. 1990 Apr;9(2):102–107. [PubMed] [Google Scholar]
- Vafidis G. C., Marsh R. J., Stacey A. R. Bacterial contamination of intraocular lens surgery. Br J Ophthalmol. 1984 Aug;68(8):520–523. doi: 10.1136/bjo.68.8.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wang W. L., Everett E. D., Johnson M., Dean E. Susceptibility of Propionibacterium acnes to seventeen antibiotics. Antimicrob Agents Chemother. 1977 Jan;11(1):171–173. doi: 10.1128/aac.11.1.171. [DOI] [PMC free article] [PubMed] [Google Scholar]