Vol.14
No. 1, Januray, 2004
Microbial
Profile of Anterior Chamber Aspirates in Cataract Surgery
using Different Techniques
SV Singh, Ved Pal, Ashok Garg, CS Dhull
Cataract
surgery like other surgical procedures is not devoid of
complications. Despite modern microsurgical and
sterilization techniques endophthalmitis is still a
devastating complication of cataract surgery. Though its
incidence has declined from 10%1 to 0.05%.2
The reaction of body to infection depends upon the virulence
of organism, immunity of patient and resistance of particular
tissue to organism.
Bacterial
endophthalmitis is caused by staph. epidermidis, staph. aureus,
pseudomonas and anaerobes. Intraoperative sources of
infection can be from conjunctival sac,3
intraocular lenses4, irrigating solutions,5
instruments and the surgeon.6 We have conducted
this study to know and compare AC contamination keeping in
mind the duration of surgery, type of wound and surgical
technique used.
MATERIAL AND
METHODS
Present study was conducted on 180 patients of senile
cataract undergoing surgery. Patients having previous surgery,
trauma in past, clinical evidence of local or systemic
infection, malignancy, treatment with immunosuppressive and
intra-operative complication were not included in this study.
Patients were randomly divided into 3 equal groups.
Group I
patients underwent extra capsular cataract extraction (ECCE).
Group II and Group III patients underwent ECCE with PCIOL and
manual small incision cataract surgery (MSICS) with PCIOL
respectively. 0.2ml of anterior chamber (AC) aspirate was
taken just after completion of surgery and was sent for Gram's
staining and for bacterial and fungus culture.
OBSERVATIONS
Mean age of the patients included in this study was 62.14 +
7.14 years. There were 88 males and 92 females.
There was no statistically significant difference in the
demographic profile of patients in the 3 groups. The
average duration of surgery was 17.72 minutes with a range of
8-35 minutes. There was no statistically significant
difference in the duration of surgery in all the three groups.
Gram's staining
was positive in 30(16.66%) eyes. In group 1, 10 (16.66%)
patients had positive staining. In Group II 14 (23.32%)
patients were positive for gram's stain. Group III
patients showed 6(10%) Gram's smears to be positive. There was
no statistically significant difference in the Gram's smear
positivity rate according to age, sex and duration of surgery.
On culture,
bacterial growth was seen in 22 (12.22%) eyes. Group I
patients had positive culture in 8 (13.33%), group II in 10
(16.66%) and group III in 4 (6.66%) eyes only. Growth proved
to be Staph. epidermidis in 14 (63.63%), Staph. aureus in 4
(18.19%), Diphtheroid in 2 (9.09%) and proteus mirabilis in
(9.09%) eyes. None of the culture for fungus showed growth.
DISCUSSION
With advanced surgical technique such as Manual small
incision cataract surgery with scleral tunnel incision (MSICS)
and phacoemulsification employing modern asepsis, many of the
complications especially endophthalmitis have been drastically
reduced in incidence. But once it occurs it is devastating.
As per literature there is varying incidence of contamination
of AC contents following different surgical techniques.
Duration of surgery, intra-operative complication and type of
surgical wound also influence intra-operative contamination.1
In this study,
we have found that Gram's smear positivity rates and growths
on culture are less with MSICS using scleral tunnel incision.
Thus length and type of entry would have significant role. So
AC contamination is less with MSICS with PCIOL using scleral
tunnel incision which is due to subsequent entry of
contaminants in anterior chamber.
REFERENCES
-
Jaffe
NS, Jaffe MS, Jaffe GF. Cataract surgery and its
complication. 6th ed. St. Louis: Mosby Year Book; 1997.
-
Allen
HF, Mangiaracine AB. Bacterial endophthalmitis after
cataract extraction. ARch ophthalmol 1974;91:3-7.
-
Miller
SJH. Parson's diseases of the eye. 18th ed. Edinburg:
Churchill Livingstone, 1990.
-
Vafadis
GC, Marsh RJ Stacey AR. Bacterial contamination of
intraocular lens surgery. Br J Ophthalmol 1984;68:520-3.
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Dickey
JB, Thompson KD, Jay WH. Intra-ocular gentamicin and post
cataract anterior chamber aspirate cultures. J Cat Ref
Surg 1994;20:373-7.
-
Allen
HF, Mangiaracine AB. Bacterial endophthalmitis after
cataract extraction. Arch ophthalmol 1964; 72:454-62.
Address
for Correspondence
Dr. SV Singh, Deptt. of Ophthalmology,
Pt. BD Sharma, PGIMS, Rohtak.
