| Endophthalmitis is one of the severe complications of intraocular surgery. Although the rate of endophthalmitis after cataract surgery is low,it affects visual function severely,and causes the enucleation of eyeball,Therefore,the prevention of endophthalmitis is very important. Numerous studies show that the ocular surface and the eye are the main source of bacteria which leads to endophthalmitis. Therefore, reducing pathogen of preoperative ocular surface is able to prevent endophthalmitis. Preoperative antibiotic eye dropping achieve a certain degree of cleanliness, while the patients'eyes are constantly exposed to the environment, and the conjunctival sac is relatively bacterial. Thus, the washing conjunctival sac is particularly important. In abroad, the main application of preoperative conjunctival sac wash is povidone-iodine solutionsh, while we use normal saline or gentamicin domesticly, and povidone-iodine in the domestic application is at the exploratory stage.Povidone iodine, also known as naloxone iodine, PVP - I, and its latin name is Povidonumiodum, its english name is Povidone– Iodine. Its effect of anti-bacteria is strong, fast, and none stimulation of mucosa . Povidone-iodine for the polymer with povidone iodine complex, one of povidone with hydrophilic, as the carrier, the complex will be transported to the cell membrane of iodine on the release of free iodine. Once the iodine getting to the cell wall, the rapid release of free iodine cytotoxicity in 10 seconds to kill prokaryotic cells. After the consumption of iodine and complexation status from the povidone iodine added to Medium. Until the available iodine was exhausted. And povidone-iodine disinfectant solution at certain concentrations has non-toxic side effects, non-irritating to human beings, and it also does not produce drug-resistant strains, being contaminated, mutagenic, teratogenic effect, and does not easily produce allergic reactions, even for patients with iodine allergy rarely have allergic symptoms.In this study, we compared normal saline, gentamicin, and povidone-iodine in the conjunctival sac wash. And try to find a suitable way of conjunctial sac wash in the morning before surgery. We collected 120 cases of cataract patients (over the age of 50)with 120 eyes from Feb. 2008 to Mar. 2009 who are going to take ultrasound emulsification and IOL implantation in second hospital of Jilin University.male 54 cases, and female 66 cases. The average age is 66 years.The patients were randomly divided into three group with 40 cases of each group.On the day before the surgery, all preoperative eye was given 0.3% levofloxacin eye drops of 8 times. And before we did pre-operative cleaning treatment, the patients in each group were taken conjunctival sampling for bacterial culture, and then separately with 3 different types of conjunctival sac fluid as a flushing fluid for conjunctival flush. Three groups of patients were washed at the same height (50cm), temperature (normal room temperature) and washing time (1min). We washed the skin around the eyes, palpebral margin, the roots of eyelashes, and inner canthus as well.Group A: normal saline 100 ml washing eye, group B: 0.08% gentamycin in 100 ml of eye, group C: 0.25% povidone-iodine eye two milliliters of normal saline followed by 100 ml of washing Conjunctival sac.2 minutes later, we took samples for bacteriological culture, and then proceed to inspect and corneal fluorescein tear film break-up time (BUT) check,As well as adverse reactions (irritation, acid, tears, foreign body sensation) conducted a questionnaire survey.The results showed that: 120 conjunctival specimens were taken before washing, there are 49 cases of conjunctival bacterial culture, positive rate was 40.8%, We cultivated 54 bacteria strains totally. Conjunctival bacteria is mainly gram-positive cocci, accounting for 79.6%, are the major hyperparasite conjunctival sac, staphylococcus bacteria total positive rate of 74%, of which coagulase-negative staphylococci(Staphylococcus epidermidis) 35.2%, coagulase - positive staphylococci (Staphylococcus aureus) 25.9%, In addition, beyond viridans streptococci,gram-positive cocci have aureus (5.6%), Tetrads (12.9%), Gram-negative bacteria Pseudomonas aeruginosa is mainly (9.2%). Gram-positive bacteria was mainly Corynebacterium (11.1%).The detective rate of conjunctival bacteria from patients with age less than 65 was 28.8%, while for those who beyond 65 years, the rate was 52.5%,there was a significant difference (P <0.05). Left eye carrier rate was 37.9%, the right eye for the carrier rate was 43.5% ,no significant difference (P > 0.05). Male conjunctiva capsule carrier rate was 27.8%, and for females, the rate was 51.5%, there was a significant difference (P <0.05).Before flushing, the bacterial culture-positive rates of saline group, gentamycin group, and povidone-iodine group were 40%, 40%, and 42.5%, respectively.While after flushing administration, the rates decreased into 20%, 10%, 0%. Among the three comparison of the effect of the difference has statistical significance (P <0.05), among which povidone-iodine group was the best. For corneal staining after washing, there was not statistically significant difference (P >0.05); tear film break-up time was not significant (P >0.05). Adverse reaction rates were 45%, 47.5%, 42.5%, and the difference was not significant (P >0.05).The results show that: comparing with the saline group and the gentamicin group, povidone-iodine can effectively clear the conjunctival bacteria in patients, and did not affect the tear film break-up time. There is a slight side effect on corneal epithelium, but did not lead to further injury, and no case of postoperative patients with corneal edema ,and endophthalmitis.In order to reduce the postoperative endophthalmitis, the primary goal is to reduce the micro-organisms entering into the anterior chamber during surgeries Even though a large number of broad-spectrum antibiotics were being used effectively, endophthalmitis after cataract surgery still happens. Lots of pre-operative risk factors tend to infection. Early attention can prevent serious consequences, and the clinical applications of povidone iodine play a key role for post operative endophthalmitis prevention.We researched on the application of domestic povidone-iodine in conjunctival sac flushing in the morning on the day of surgery. It played a key role of conjunctival sterile procedure, and provided a theoretical basis on preoperative preparation of intraocular surgeries. And it may guide for the prevention of endophthalmitis. |
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