Etiological Characteristics And Preventive Measures Of Infection During Perioperation Of Cataract Surgery

Objective:Although the incidence of postoperative bacterial endophthalmitis is rare, it is a devastating complication that can occur after routine cataract surgery. A large number of relevant studies confirm that the main risk factor for endophthalmitis may be associated with the intraocular exposure to the patient’s own normal ocular surface and adnexal flora, and bacteria of lid margins and conjunctiva determine the level of postoperative infection rates to some extent. This study aims to investigate the structure and characteristics of pathogens of conjunctival sac and lid margins and get a step further to explore the clinical effect of the corresponding infectious prevention measures.Materials and Methods:In this study conducted in Chinese PLA General Hospital, clinical data about 80 eyes (80 patients) were collected from March 2014 to February 2015. According to the results of pathogen cultivation of conjunctival sac and lid margins and susceptibility testing, to study the characteristics and structure of the pathogens and the sensitivity and resistance of antibacterial drugs. The preoperative infectious prevention measures include the application of 0.5% levofloxacin eye drops, 0.0025% povidone-iodine solution, sterile surgical foil wrapped the lashes and lid margins and 0.7% tobramycin solution. To study the diversity of pathogens of conjunctival sac and lid margins after different infectious prevention measures.Results:The positive rate of bacterial culture of lid margins and conjunctival sac was 65% and 37.5% respectively. The gram-positive bacteria accounted for 96.5%: Staphylococcus epidermidis(62.2%), Corynebacterium(28.7%),other gram-positive bacteria(5.6%); gram-negative bacteria accounted for 3.5%. After the use of 0.5% levofloxacin eyedrops, the positive rate of bacteria culture in two sites decreased significantly (20%,40%). With the application of PVP-iodine solution, surgical membrane and tobramycin solution, the bacteria culture turned to be negative. At the end of surgery, it was found to be negative in the bacteria culture of anterior aqueous fluid, while there were 7 cases with palpebral magin cultured positive and all of which were S.epidermidis.Conclusions:The positive rate of bacterial culture was significantly higher in lid margins than conjunctival sac, while there was tiny differences in the components of pathogens in two sites. The older patients are inferred to have a higher risk of infection. The combination with levofloxacin eye drops, povidone iodine solution, sterile ophthalmic surgery foil and tobramycin solution can achieve the sterile state of the eye for surgery. Take control of source of infection reasonably is an effective way to decrease the incidence of infections. In addition, it is important to segregate lid margins during the surgery for the reason that the glands of eyelid can contaminate the operative eye as well.