Anterior chamber contamination during cataract surgery with intraocular lens implantation.
OBJECTIVE
To measure anterior chamber bacterial and fungal contamination at the beginning and end of cataract surgery with intraocular lens (IOL) implantation in a large series of patients and to determine the influence of preoperative treatment and operative technique on contamination.


METHODS
Department of Ophthalmology, County Hospital of Salzburg, Austria.


METHODS
This prospective study comprised 700 consecutive patients having planned cataract extraction (511 phacoemulsification, 189 extracapsular cataract extraction [ECCE]). Thirty-four patients required an anterior vitrectomy; 8 myopic patients did not receive an IOL. A preoperative smear and two intraoperative (at the beginning and end of surgery) anterior chamber aspirates were obtained from each patient. Postoperative smears were obtained at discharge. Three preoperative treatments were evaluated: no lacrimal system irrigation, no topical antibiotic (n = 282); lacrimal system irrigation with balanced saline solution, no topical antibiotic (n = 243); lacrimal system irrigation, antibiotic (neomycin) eyedrops (n = 175). All patients received topical indomethacin twice a day preoperatively.


RESULTS
Preoperative conjunctival smears showed bacterial growth in 76.6% of eyes, with coagulase-negative staphylococci (75%) the most common bacteria. Anterior chamber aspirates were culture positive in 14.1% at the beginning and in 13.7% at the end of surgery, with coagulase-negative staphylococci and corynebacteria the most common. Contamination rates of conjunctival smears taken at discharge were significantly lower (35%) than those taken preoperatively. There was no statistically significantly higher risk of anterior chamber contamination in eyes having ECCE than in those having phacoemulsification. Preoperative treatment did not statistically significantly influence intraoperative aqueous humor contamination rates. There were no cases of acute postoperative endophthalmitis.


CONCLUSIONS
Bacteria entered the anterior chamber during cataract extraction and remained there at the end of surgery in a significant percentage of patients. Surgical technique, preoperative antibiotics, and preoperative lacrimal system irrigation had no statistically significant effect on contamination.
Mistlberger
A
A
Department of Ophthalmology, County Hospital of Salzburg, Germany.
Ruckhofer
J
J
Raithel
E
E
Müller
M
M
Alzner
E
E
Egger
S F
SF
Grabner
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001419:Bacteria / Q000302:isolation & purification; D002387:Cataract Extraction / Q000009:adverse effects*; D015169:Colony Count, Microbial; D003228:Conjunctiva / Q000382:microbiology; D009877:Endophthalmitis / Q000382:microbiology* / Q000517:prevention & control; D015818:Eye Infections, Bacterial / Q000209:etiology* / Q000517:prevention & control; D015821:Eye Infections, Fungal / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage; D009883:Ophthalmic Solutions; D011446:Prospective Studies; D014821:Vitrectomy
D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D009355:Neomycin