ABSTRACT
PURPOSE: To analyze antibiotic resistance and genetic profile of conjunctival bacteria flora before and after cataract surgery with the focus on coagulase-negative staphylococci (CNS) during cataract surgery and discuss the implications of this colonization as a potential risk of acquiring endophthalmitis. METHODS: After approval of the institutional review board and informed consent from patients had been obtained, conjunctival swabs for culture from 59 patients undergoing cataract surgery were taken of the fellow eye at baseline (C0) and from the eye to be operated before (T0) and after (T1) irrigation with povine-iodine 5%, and at the end of surgery (T2). Genes responsible for virulence (mecA, ica and atlE) and antibiotic profile were determined; strain clonality of persistent colonizing Staphylococcus epidermidis strains was established by the Multi-locus sequence typing (MLST). RESULTS: The frequency of CNS was significantly reduced in T1 (13.6%) from 81.4% in T0 and 86.4% in C0. The frequency of mecA, ica and atlE genes was 34.4%, 37.5% and 61.4%, respectively; and methicillin phenotypic resistance was 35.4%. S. epidermidis was the most frequent species isolated in every time point. MLST revealed in 7 patients 100% coincidence of the seven alleles of the S. epidermidis isolated previous to povine-iodine 5% disinfection and at the end of the surgery. CNS isolates from T1 or T2 corresponded to the same species, antibiotic and virulence profile as those isolates from C0 or T0. CONCLUSION: Povidone-iodine 5% prophylaxis before surgery significantly reduced conjunctival contamination; in those that persisted, the source of contamination was mostly the patient's microbiota confirmed by the MLST system.
Subject(s)
Cataract Extraction , Cataract , Iodine , Humans , Multilocus Sequence Typing , Genetic Profile , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Conjunctiva , Staphylococcus/genetics , Bacteria , Drug Resistance, MicrobialABSTRACT
Para determinar la frecuencia de rotura de cápsula posterior (RCP) durante la cirugía de catarata, el manejo intra y postoperatorio y la agudeza visual (AV) final, se realizó un estudio observacional, retrospectivo, con fichas de pacientes sometidos a cirugía de catarata en nuestro servicio entre Abril de 2007 y Marzo de 2008. Se analizaron datos demográficos, antecedentes patológicos, AV pre y postoperatoria, alteraciones a nivel del fondo de ojo, técnica quirúrgica, experiencia del cirujano, pérdida de vítreo durante la cirugía, tipo de vitrectomía, implante de lente intraocular, complicaciones postoperatorias. Setecientos cincuenta y cuatro pacientes fueron sometidos a cirugía de catarata en el periodo de estudio, 54 (7.1%) presentaron RCP. Se seleccionaron fichas de 49 pacientes con RCP para el análisis de las variables. La edad promedio fue de 69 años, 38 pacientes (76%) tenían AV preoperatoria de cuenta dedos a buena percepción luminosa, 10 pacientes (20.4%) presentaban dilatación pupilar menor a 6mm y 19 (38.8%) pseudoexfoliación capsular, 73.5% fueron operados por residentes. Se realizó extracción extracapsular en el 79.6% de los casos. El 73.5% presentó pérdida de vítreo y se realizó vitrectomía, 69.4% recibió implante de lente intraocular y 26.5% presentó complicaciones postoperatorias. El 75.5% de los pacientes llegó a una AV postoperatoria mejor a 20/140. Se encontró relación estadísticamente significativa al comparar la AV postoperatoria con la presencia de complicaciones (p: 0.01). La RCP es una complicación a la que están expuestos todos los cirujanos de catarata y el manejo adecuado es fundamental para evitar en lo posible las complicaciones y lograr una buena AV.
To determine the frequency of the posterior capsule rupture (PCR) during cataract surgery, the intra and post-operatory management and the final visual acuity (VA) an observational retrospective study was carried out with the records of patients subjected to cataract surgery in our service from April 2007 to March 2008. Demographic data, pathological records, pre and postoperative VA, alterations of the fundus of the eye, surgical technique, experience of the surgeon, vitreous loss during the surgery, vitrectomy type, implant of intraocular lenses, postoperative complications. Seven hundred fifty four patients were subjected to cataract surgery during the study period, 54 (7.1%) presented PCR. Records of 49 patients with PCR were selected for the variable analysis. Mean age was 69 years old, 38 patients (76%) had preoperative AV of count fingers to light perception, 10 patients (20.4%) presented pupil dilation lower than 6 mm, 19 (38.8%) showed capsular pseudoexfoliation and 73.5% were operated by residents. Extracapsular extraction was made in 79.6% of the cases. The 73.5% presented vitreous loss and were subjected to vitrectomy, 69.4% received implant of intraocular lenses and 26.5% presented post-operatory complications. The 75.5% of the patients achieved a post-operatory VA better than 20/140. A statistically significant relation was found when the post-operatory VA was compared with the presence of complications (p: 0.01). The PCR is a complication to which all cataract surgeons are exposed to and the adequate management is essential to avoid complications as much as possible and achieve good VA.
