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Japanese Journal of Ophthalmology

, Volume 57, Issue 1, pp 74–79 | Cite as

Bacterial culture after three sterilization methods for cataract surgery

  • Keiji InagakiEmail author
  • Tatsuo Yamaguchi
  • Sachiko Ohde
  • Gautam A. Deshpande
  • Kazukuni Kakinoki
  • Kishiko Ohkoshi
Clinical Investigation

Abstract

Purpose

To compare bacterial cultures from three sterilization methods immediately before and after cataract surgery.

Design

A prospective randomized open-label group-comparison study.

Methods

We investigated 75 eyes in 73 consecutive patients undergoing cataract surgery. After swabbing the eyelid and surrounding area, patients were randomly assigned to one of 3 eye-washing methods: patients administered one drop of 5 % povidone–iodine (Group A); patients whose conjunctival sac was washed with 0.02 % chlorhexidine while everting the eyelid (Group B); or 0.02 % chlorhexidine as above but without eyelid eversion (Group C). In each group, specimens were collected from the conjunctival sac immediately before and after eye washing and again at completion of surgery, along with aqueous humor. The post-surgical condition of the corneal epithelium and the severity of anterior chamber inflammation were assessed by use of a slit-lamp microscope.

Results

In Groups A and C, the percentage of eyes with conjunctival bacteria decreased significantly from immediately before to immediately after washing (Group A, p = 0.008; Group C, p = 0.016), but there was no significant decrease in Group B (p = 0.125). Slit-lamp microscopy showed that inflammation of the anterior chamber 1 day after surgery was significantly milder in Group C than in Group B (p = 0.032).

Conclusion

Eye-washing methods without eyelid eversion are more effective in reducing conjunctival bacteria before surgery and anterior chamber inflammation after surgery than those with eyelid eversion.

Keywords

Ocular sterilization Cataract surgery Endophthalmitis Povidone–iodine Eyelid eversion 

References

  1. 1.
    Lindstrom M, Weide G, Stenevi U, Thorburn W, Montan P. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation type and location. Ophthalmology. 2007;114:866–70.CrossRefGoogle Scholar
  2. 2.
    Hara T, Hoshi N, Hara T. Changes in bacterial strains before and after cataract surgery. Ophthalmology. 1996;103:1876–9.PubMedGoogle Scholar
  3. 3.
    Leong JK, Shah R, McCluskey PJ, Benn RA, Taylor RF. Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery. J Cataract Refract Surg. 2002;28:826–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery. An evidenced-based update. Ophthalmology. 2002;109:13–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Mamalis N. Endophthalmitis. J Cataract Refract Surg. 2002;28:729–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Speaker MG, Menikoff JA. Prophylaxis of endophthalmitis with topical povidone–iodine. Ophthalmology. 1991;98:1769–75.PubMedGoogle Scholar
  7. 7.
    Inoue Y, Usui M, Ohashi Y, Shiota H, Yamazaki T. Preoperative Disinfection Study Group: preoperative disinfection of the conjunctival sac with antibiotics and iodine compounds: a prospective randomized multicenter study. Jpn J Ophthalmol. 2008;52:151–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Seal DV, Barry P, Gettinby G, Lees F, Peterson M, Revie CW, et al. ESCRS Endophthalmitis Study Group: ERCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: case for a European multicenter study. J Cataract Refract Surg. 2006;32:396–406.PubMedCrossRefGoogle Scholar
  9. 9.
    Barry P, Seal DV, Gettinby G, Lees F, Peterson M, Revie CW. ESCRS Endophthalmitis Study Group: ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32:407–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Hori Y, Nakazawa T, Maeda N, Sakamoto M, Yokokura S, Kubota A, et al. Susceptibility comparisons of normal preoperative conjunctival bacteria to fluoroquinolones. J Cataract Refract Surg. 2009;35:475–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Shimada H, Arai S, Nakashizuka H, Hattori T, Yuzawa M. Reduction of anterior chamber contamination rate after cataract surgery by intraoperative surface irrigation with 0.25 % povidone–iodine. Am J Ophthalmol. 2011;151:11-7.Google Scholar
  12. 12.
    Fernandez-Rubio E, Urcelay JL, Cuesta-Rodriquez T. The antibiotic resistance pattern of conjunctival bacteria: a key for designing a cataract surgery prophylaxis. Eye. 2009;23:1321–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Dickey JB, Thompson KD, Jay WM. Anterior chamber aspirate cultures after uncomplicated cataract surgery. Am J Ophthalmol. 1991;112:278–82.PubMedGoogle Scholar
  14. 14.
    Endophthalmitis Vitrectomy Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995;113:1479–96.CrossRefGoogle Scholar
  15. 15.
    Meisler DM, Mandelbaum S. Propiobacterium-associated endophthalmitis after extracapsular cataract extraction. Review of reported cases. Ophthalmology. 1989;96:54–61.PubMedGoogle Scholar
  16. 16.
    Kitano S. Preoperative administration of antibiotics for cataract surgery. Jpn J Ophthalmic Surg. 1995;8:717–9.Google Scholar

Copyright information

© Japanese Ophthalmological Society 2012

Authors and Affiliations

  • Keiji Inagaki
    • 1
    Email author
  • Tatsuo Yamaguchi
    • 1
  • Sachiko Ohde
    • 2
  • Gautam A. Deshpande
    • 2
  • Kazukuni Kakinoki
    • 1
  • Kishiko Ohkoshi
    • 1
  1. 1.Department of OphthalmologySt. Luke’s International HospitalTokyoJapan
  2. 2.Center for Clinical EpidemiologySt. Luke’s Life Science InstituteTokyoJapan

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