Contaminación bacteriana de cámara anterior durante la cirugía de catarata / Anterior chamber bacterial contamination during cataract surgery

RESUMEN Objetivo: Determinar la existencia de contaminación bacteriana en cámara anterior durante la cirugía de catarata. Métodos: Se realizó un estudio transversal de serie de casos, en el cual participaron los pacientes sometidos a cirugía de catarata en el Servicio de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de enero del año 2015 a diciembre 2016. Se relacionaron los antecedentes patológicos personales oculares y sistémicos, los factores de riesgo asociados y las complicaciones transoperatorias con la presencia de bacterias en la cámara anterior al final de la cirugía. Los pacientes fueron seleccionados aleatoriamente en el salón de cirugía. La muestra quedó constituida por 200 pacientes y divididos en tres grupos dependiendo de la experiencia de los cirujanos. Resultados: Al inicio del proceder quirúrgico, el 100 por ciento de los cultivos fueron negativos, mientras que al final de la cirugía se detectó crecimiento bacteriano en el 3 por ciento. Los gérmenes Gram positivos fueron los de mayor frecuencia (66,6 por ciento) donde el Staphylococcus epidermidis se aisló en un 50 por ciento de los casos. No existió relación significativa entre antecedentes patológicos personales oculares, sistémicos y los factores de riesgo asociados. La ruptura de la cápsula posterior fue la complicación transoperatoria más frecuente y al 4,7 por ciento se le detectó crecimiento bacteriano. Conclusión: Se detecta una baja frecuencia de contaminación de la cámara anterior al final de la cirugía de catarata y los gérmenes comúnmente encontrados están relacionados con la microbiota de la superficie ocular(AU)

ABSTRACT Objective: Determine the presence of anterior chamber bacterial contamination during cataract surgery. Methods: A cross-sectional case-series study was conducted of patients undergoing cataract surgery at the Ocular Microsurgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2015 to December 2016. Personal ocular and systemic pathological antecedents, associated risk factors and perioperative complications, were related to the presence of anterior chamber bacterial contamination at the end of surgery. Patients were randomly selected in the operating room. The sample was composed of 200 patients, who were divided into three groups according to the surgeons' experience. Results: At the start of the surgical procedure, 100 percent of the cultures were negative, whereas at the end 3 percent bacterial growth was detected. Gram-positive germs were the most common (66.6 percent), with Staphylococcus epidermidis isolated in 50 percent of the cases. No significant relationship was found between personal ocular or systemic pathological antecedents and associated risk factors. Posterior capsule rupture was the most frequent intraoperative complication, with 4.7 percent bacterial growth detected. Conclusion: Low frequency of anterior chamber contamination was detected at the end of cataract surgery, and the germs commonly found are related to the ocular surface microbiota(AU)

Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.

Aim: To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics. Materials and Methods: Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured. Results: Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates’ correction). Conclusion: Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.

Necrotizing nocardial scleritis after combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation: a case report and review of the literature

We report the history and clinical presentation of an 88-year-old female with Fuchs dystrophy who developed an acute anterior necrotizing scleritis in her left eye 23 months after an uncomplicated combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation which progressed to slceral perforation with uveal prolapses. The patient underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis. Surgical specimens of the area of scleral perforation were sent for histology and microbiologic studies. Analysis of surgical specimens revealed the presence of culture-proven Nocardia asteroides as a causative agent for the patient's scleral perforation. Results of her systemic autoimmune work-up were not conclusive. Successful treatment with tectonic scleral reinforcement with donor corneal tissue and preserved pericardium, oral and topical trimethoprim-sulfamethoxazole and topical amikacin salvaged the globe and increased vision. The patient's final best-corrected visual acuity sixteen months after her last operation remains 20/70. Prompt surgical intervention with submission of appropriate specimens for pathological diagnosis and microbiology, along with consultation with rheumatologic and infectious disease specialists, are mandatory to minimize visual loss in cases of suspected infectious necrotizing scleritis.

Relato de caso de esclerite necrosante aguda, evoluindo para perfuração escleral com prolapso uveal, 23 meses após procedimento de ceratoplastia penetrante e facoemulsificação com implante de lente intra-ocular no olho esquerdo sem intercorrências.A paciente foi submetida à avaliação completa auto-imune para esclerite. Biópsia da área de perfuração escleral foi encaminhada para avaliação patológica e microbiológica. Análise de material cirúrgico revelou presença de cultura proveniente de Nocardia asteroides como agente causal da perfuração escleral. Resultados de exames do sistema auto-imune não foram conclusivos. Tratamento foi um sucesso com reforço escleral tectônico do tecido corneano doador, utilização de pericárdio preservado, associado ao uso sistêmico e tópico de sulfametoxazol-trimetropina e amicacina colírio. Apresentou melhora visual após o tratamento e a melhor correção visual final, 16 meses após o último procedimento cirúrgico foi de 20/70. Intervenção cirúrgica precoce, análise patológica e microbiológica do material, associados a consulta a especialistas na área de doenças infecciosas e reumatologia, são primordiais para minimizar perda visual em casos de suspeitas de esclerite infecciosa necrosante.

Contaminação bacteriana da câmara anterior pós-facoemulsificação com implante de lente intra-ocular de polimetilmetacrilato ou silicone / Bacterial anterior chamber contamination after phacoemulsification and polymethylmethacrylate or silicone intraocular lens implantation

OBJETIVO: Avaliar a contaminação bacteriana da câmara anterior, após facoemulsificação não complicada, com tamanhos diferentes de incisões e lentes intra-oculares. MÉTODOS: Foi realizado estudo prospectivo randomizado, de 80 olhos de 80 pacientes, submetidos à facoemulsificação sob anestesia tópica, distribuídos aleatoriamente em dois grupos iguais. No grupo A foram alocados os pacientes submetidos à cirurgia com incisão de 3,0 mm, lente intra-ocular dobrável de silicone implantadas com injetor. No grupo B os pacientes foram submetidos à cirurgia com incisão de 5,8 mm e implante de lente intra-ocular de polimetilmetacrilato de peça única, com pinça. Ao final de cada cirurgia, uma amostra do líquido da câmara anterior foi colhida e semeada em meios de cultura para bactérias. RESULTADOS: A cultura do líquido da câmara anterior foi positiva em 2,5 por cento dos casos do grupo A e em 5,0 por cento do grupo B. Não houve diferença estatisticamente significante entre os dois grupos (qui² = 0, 380, p> 0,05). CONCLUSAO: O implante de lente intra-ocular através de incisão menor, não resultou em menor contaminação da câmara anterior na cirurgia de facoemulsificação.

Inhibición de crecimiento bacteriano en aspirado de cámara anterior, usando gentamicina en la solución de irrigación en facoemulsificación con implante de lente intraocular / Bacterial grouth inhibition in the anterior chamber aspiration using gentamicine in the irrigation solution during phacoemulsification and IOL implantation

Se efectuó cultivo del líquido aspirado de CA, en el postoperatorio inmediato de facoemulsificación +LIO en 109 ojos; se usaron medios para bacterias aerobias y anaerobias; se determinó la sensibilidad a la gentamicina de las bacterias aisladas y se cuantificaron las unidades formadoras de colonias (UFC). De forma aleatoria, en 54 casos se agregó gentamicina a la solución de irrigación y en 55 no se les adicionó. Se obtuvieron 18 cultivos positivos, 5 de ellos en pacientes con antibiótico y en 13 sin antiobiótico. La prueba de Xi² fue de 0.043. Excepto por un caso con Flavobacterium spp y uno con Cardiobacterium hominis, los microorganismos aislados correspondieron a flora conjuntival habitual. Todos los UFC fueron bajos

Bacterial contamination of anterior chamber during IOL surgery.

PURPOSE: To study the nature and frequency of bacterial contamination during cataract surgery. METHODS: The preoperative smears from the conjunctiva and anterior chamber (AC) fluid aspirates during extra-capsular cataract surgery (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in 40 eyes were analysed for aerobic and anaerobic bacteria. Any change in the bacterial strains isolated before and after cataract surgery was also studied. RESULTS: AC fluid aspirates were positive for bacteria in 15 eyes (37.5%). Coagulase-negative Staphylococcus was the most common aerobe (39.4%) and Propionibacterium acnes the most common anaerobe. Of the 15 cases with positive AC fluid cultures, 6 showed an organism in the AC aspirate different from the conjunctival smear. CONCLUSION: Clinically there was no endophthalmitis in any of the eyes. Factors such as preoperative antibiotic use, the antibacterial properties of aqueous, or low inoculum size could explain this. The preoperative conjunctival smear may not be useful in predicting the AC fluid contamination or outcome of cataract surgery.

Microbiological profile of anterior chamber aspirates following uncomplicated cataract surgery.

Anterior chamber aspirate cultures were done for 66 patients who underwent either an uncomplicated intracapsular cataract extraction, extracapsular cataract extraction with posterior-chamber intraocular lens implantation, or phacoemulsification with posterior-chamber intraocular lens implantation. The aspirate was obtained at the time of wound closure. The aspirates were immediately transferred to the microbiology laboratory where one drop of the aspirate was placed on a glass slide for gram stain, and the remainder was unequally divided and inoculated into blood agar, chocolate agar and thioglycolate broth. The cultures were incubated at 37 degrees C with 5% CO2 and held for 5 days. Of 66 patients 4 (6%), had smear-positive anterior chamber aspirates. None of the aspirates showed any growth on any of the 3 culture media used. None of the eyes in the study developed endophthalmitis. This study concludes that there is no contamination of the anterior chamber by viable bacteria after cataract surgery, irrespective of the mode of intervention.

Bilateral iridocyclitis caused by Mycobacterium leprae diagnosed through paracentesis.

The authors conducted an anterior chamber paracentesis in a patient with lepromatous leprosy showing bilateral iridocyclitis. The paracentesis was performed in the outpatients department. The aqueous humor was studied by Ziehl-Nielsen staining method and the result was the isolation of the M. leprae in the anterior chamber. This study shows that M. leprae can promote uveitis in leprosy patients. Therefore, it should be looked for in patients having this type of disease.