Microbiology of corneal wounds after cataract surgery: biofilm formation and antibiotic resistance patterns.

OBJECTIVE: To evaluate the bacterial flora of corneal wounds at the end of cataract surgery before intracameral antibiotic use and to determine agents to treat postoperative endophthalmitis, the potential for biofilm formation, and antibiotic resistance. METHOD: This cross-sectional clinical study included patients who underwent cataract surgery using the phacoemulsification technique without any complications. The hemifacial skin, periocular area, eyelids and eyelashes were washed with 10% povidone-iodine and the conjunctiva was washed with 5% povidoneiodine before cataract surgery. After uncomplicated surgery, a wipe sample was taken from the bulbar conjunctival surface, corneal surface, and wound rim before administering intracameral antibiotics. All samples were plated on blood agar, MRS agar, M17 agar, calcium-lactate agar, plate-count agar, and Sabouraud-dextrose agar. Biofilm formation was evaluated by microtitre plates and the Congo red-agar method. Antimicrobial resistance patterns of isolates were determined by the agar-disk diffusion method. RESULTS: We recruited 50 patients and studied 55 eyes, obtaining 34 isolates from the cultures of 16 eyes. Isolated organisms were coagulase-negative staphylococci (CoNS) (35.3%), Bacillus cereus (29.4%) and Pseudomonas spp. (5.9%). We obtained isolates from 64% of diabetic cases and 20% of non-diabetic cases, (p=0.002). It was observed that 21 out of 34 isolates produced a weakly positive biofilm, 8 were moderately positive, three were strongly positive, and two isolates were biofilm negative. Of the CoNS strains four of the 11 were resistance to four or more antibiotics. CONCLUSION: Microorganisms that remained at the end of cataract surgery had the capacity to produce biofilm and had high antibiotic resistance. Appropriate preoperative disinfection is very important and adequate disinfection and suitable antibiotics should be kept in mind for avoiding endophthalmitis, especially for diabetic patients. Biofilm is one of the major factors affecting the virulence of bacteria, and further studies into prevention of biofilm formation are required in this area.

Nursing Care after Surgical Treatment of Fungal Endophthalmitis in Children.

PURPOSE: To explore the nursing care following surgical treatment of fungal endophthalmitis in children. METHODS: Thirty two children (32 eyes) with fungal endophthalmitis were enrolled in this study. After receiving antifungal medication, the children underwent either intravitreal injection, intravitreal injection of medicine combined with vitrectomy, or intravitreal injection in combination with vitrectomy and intraocular C3F8 tamponade. Prior to surgery, psychological and quarantine nursing, and medication use was properly prepared. After the surgery, the changes in the severity of diseases were strictly observed. A suitable body posture was selected and the eyes were protected from infection. RESULTS: Among 32 patients with fungal endophthalmitis, 8 (25% ) cases presented with alleviated inflammation and no changes in visual acuity. The visual acuity of 18 cases (56.25%) was improved to different extents postoperatively. The inflammation in 6 children (18.75%) was properly controlled and the visual acuity declined. No cross-infection was noted in any patient. CONCLUSION: Prior to surgery, quarantine nursing and drug administration should be properly prepared. Postoperatively, the changes in the severity of diseases should be tightly monitored. The patients should be treated with effective therapies in a proper position, aiming to enhance the surgical efficacy.

Uso de triamcinolona intracameral sin conservantes en cirugía de la catarata pediátrica. Utilidad diagnóstica y terapéutica / Use of intracameral triamcinolone in pediatric cataract surgery. Diagnostic and therapeutic usefulness

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Study of problems arising during perioperative care of postoperative endophthalmitis.

PURPOSE: To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. METHODS: The medical records of 34 patients (35 eyes) presenting with infectious endophthalmitis at Zhongshan Ophthalmic Center, Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. RESULTS: Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery. Thirty-three cases were successfully cured and only one patient (1 eye) was untreated due to Pseudomonas aeruginosa infection. CONCLUSION: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

Toxic anterior segment syndrome--more than sterility meets the eye.

TOXIC ANTERIOR SEGMENT SYNDROME (TASS) is a rare, potentially devastating complication of routine intraocular surgery that occurs when a noninfectious toxic agent enters the anterior segment of the eye, causing an inflammatory reaction. SEVERE CASES OF TASS can cause permanent harm, and if symptoms still are present after six weeks, the eye is not likely to recover. EARLY DIAGNOSIS AND TREATMENT are effective in preventing permanent damage, but often TASS is mistakenly diagnosed as infectious endophthalmitis for which treatment is completely different. THE CAUSES AND TREATMENT of TASS are discussed, and risk reduction strategies are described.

Diagnosis and treatment of chronic postoperative bacterial endophthalmitis.

Bacterial endophthalmitis has been recognized as a significant cause of chronic, delayed-onset inflammation following extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation. The diagnosis of chronic postoperative bacterial endophthalmitis should be suspected in any case of chronic, refractory inflammation following ECCE. Although successful treatment may require surgical intervention in some cases, others may respond to antibiotic therapy alone.