Vol.14
No. 1, Januray, 2004
The effect of intraoperative antibiotics in irrigating
solutions on aqueous humor contamination and endophthalmitis
after phacoemulsification surgery.
Sobaci G, Tuncer K, Tas
A, Ozyurt M, Bayer A, Kutlu U
Eur J Ophthalmol 2003 Nov-Dec;13 (9-10):773-8.
This
study was done to determine the efficacy of intraoperative
antibiotic use in irrigating solutions on aqueous humor
contamination during phacoemulsification surgery and to
evaluate the corresponding risk of postoperative
endophthalmitis. 644 eyes of 640 patients who underwent
phacoemulusification surgery with foldable intraocular lens (IOL)
implantation were included in this study. Preoperative
conjunctival smears were taken and eyes were allocated to
receive irrigating infusion fluid containing either balanced
salt solution (BSS)-only (group 1;322 eyes) or BSS with
antibiotics (vancomycin and gentamycin) during surgery (group
2;322 eyes). Bacterial contamination rates of aqueous
humor samples taken in the beginning and at the end of
operation were compared. Predictive factors for the
development of postoperative endophthalmitis were determined
by clinical and microbiologic analyses. Results showed
the rates of culture-positivity were similar between group 1
and group 2 for both preoperative conjunctival smears and
aqueous samples (p>0.05). Aqueous samples taken at
the end of operation were found to be contaminated in 68
(21.1%) eyes in group 1 and 22 (6.8%) eyes in group 2, and the
difference was significant (p= 0.001; OR = 3.65 (2.1-6.0)).
Capsular rupture was associated with higher rate of
contamination in both groups (p=0.0001; OR = 7.7 and P =
0.0001; OR = 8.1). Two eyes in the BSS -only group
developed postoperative endophthalmitis and these cases had
posterior capsular rupture during the surgery and culture-positivity
for staphylococcus epidermidis throughout the study.
CONCLUSION:
Intraoperative antibiotic irrigation decreases aqueous humor
contamination during phacoemulsification. Further
studies are warranted to determine the interrelationship
between aqueous humor contamination and endophthalmitis in
eyes with posterior capsular rupture.
