Subject(s)
Brain Death , Terminology as Topic , Heart/physiopathology , Humans , Lung/physiopathologyABSTRACT
A recent case-control study indicated that the insertion of an intraocular lens with polypropylene (Prolene) haptic materials was a significant risk factor for postoperative endophthalmitis (odds ratio = 4.5, P < .01). In the present study, we used quantitative techniques to evaluate adherence of Staphylococcus epidermidis to two intraocular lens types--lenses with polypropylene haptic materials and all-polymethyl methacrylate optic and three-piece all-polymethyl methacrylate lenses--using a quantitative culture method, a radioisotope technique, and scanning electron microscopy. All three methods demonstrated approximately twice as many bacteria adherent to lenses with polypropylene haptic materials as to all-polymethyl methacrylate lenses. Scanning electron microscopy showed preferential bacterial adherence to the polypropylene haptic materials. These data provide a pathogenic mechanism to explain our epidemiologic findings of an increased risk of postoperative endophthalmitis associated with implantation of intraocular lenses with polypropylene haptic materials.
Subject(s)
Bacterial Adhesion , Equipment Contamination , Lenses, Intraocular/standards , Polypropylenes/standards , Staphylococcus epidermidis , Adsorption , Colony Count, Microbial , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Endophthalmitis/microbiology , Isotope Labeling , Materials Testing , Methylmethacrylate , Methylmethacrylates/standards , Microscopy, Electron, Scanning , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/microbiology , Risk Factors , Sonication , Staphylococcus epidermidis/growth & development , Staphylococcus epidermidis/isolation & purificationSubject(s)
Endophthalmitis/microbiology , Eye Infections, Bacterial , Postoperative Complications/microbiology , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Glucocorticoids/therapeutic use , Humans , Postoperative Complications/drug therapy , Premedication , Risk FactorsSubject(s)
Decision Making , Legal Guardians/legislation & jurisprudence , Life Support Care/legislation & jurisprudence , Patient Participation/legislation & jurisprudence , Advance Directives/legislation & jurisprudence , Family , Illinois , Living Wills/legislation & jurisprudence , Mental Competency , Physician's Role , United States , Wills/legislation & jurisprudenceABSTRACT
The authors conducted a case-control study to identify risk factors for postoperative endophthalmitis. Fifty-four cases of patients who developed endophthalmitis after intraocular surgery at the New York Eye and Ear Infirmary during the period from January 1988 through October 1990 were identified. A control group of 228 patients was randomly selected from the 24,105 patients who underwent intraocular surgery during this same period. Logistic regression analysis identified significant independent risks associated with intraoperative communication with the vitreous cavity (risk ratio 13.7, P less than 0.001) and use of an intraocular lens with haptics made of polypropylene (risk ratio 4.5, P = 0.007). The study predicts that there would be approximately 700 fewer cases of postoperative endophthalmitis annually in the United States (approximately a 50% decrease in incidence) if intraocular lenses with haptics made of polymethyl-methacrylate, rather than polypropylene, were used exclusively.
Subject(s)
Endophthalmitis/microbiology , Postoperative Complications/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cataract Extraction , Child , Cross Infection/epidemiology , Endophthalmitis/epidemiology , Eye Infections, Bacterial/epidemiology , Female , Humans , Lenses, Intraocular , Male , Methylmethacrylates , Middle Aged , New York/epidemiology , Odds Ratio , Polypropylenes , Postoperative Complications/epidemiology , Random Allocation , Regression Analysis , Risk FactorsABSTRACT
The authors conducted an open-label nonrandomized parallel trial to examine whether the preoperative application of povidone-iodine to the ocular surface reduces the incidence of endophthalmitis after intraocular surgery. During an 11-month period, topical 5% povidone-iodine was used to prepare the conjunctiva in 1 set of 5 operating rooms, while silver protein solution was used in another set of 5 rooms. In all cases, surgeons continued to use their customary prophylactic antibiotics. A significantly lower incidence of culture-positive endophthalmitis (P less than 0.03) was observed in the operating rooms using povidone-iodine (2 of 3489 or 0.06%) compared with those using silver protein solution (11 of 4594 or 0.24%). Use of topical povidone-iodine in over 3000 cases was not associated with any adverse reactions. In a majority of the observed cases of endophthalmitis, some form of intraoperative communication with the vitreous cavity existed.
