The challenge of determining aqueous contamination rate in anterior segment intraocular surgery

• Published in: American journal of ophthalmology 2004-04, Vol.137 (4), p.662-667
• Main Authors: Ta, Christopher N., Egbert, Peter R., Singh, Kuldev, Blumenkranz, Mark S., Miño De Kaspar, Herminia
• Format: Article
• Language: English
• Subjects: Anterior Eye Segment - surgery; Anti-Infective Agents - administration & dosage; Antibiotics; Aqueous Humor - microbiology; Bacteria; Bacteria - isolation & purification; Biological and medical sciences; Cataracts; Catheterization - methods; Crystallization; Eye Infections, Bacterial - microbiology; Eye Infections, Bacterial - prevention & control; Eye surgery; Geochemistry; Humans; Medical sciences; Methods; Ofloxacin - administration & dosage; Ophthalmic Solutions; Phacoemulsification; Prospective Studies; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2003.11.057

To determine aqueous contamination rate in anterior segment intraocular surgery using two different techniques of obtaining aqueous fluid and to assess whether a 3-day application of topical 0.3% ofloxacin reduces this contamination rate compared with a 1-hour application. Randomized clinical trial. One hundred and thirty-three eyes of 130 patients undergoing anterior segment intraocular surgery were randomized to either control (64 eyes received topical ofloxacin 1 hour before surgery) or study groups (69 eyes received topical ofloxacin four times a day for 3 days before surgery in addition to 1 hour preoperatively). Eyes in both groups received a periorbital iodine scrub and two drops of topical 5% iodine. Aqueous fluid was obtained at the beginning and conclusion of surgery using a cannula passed through a paracentesis or a needle passed through clear cornea. The aqueous, cannula, and needles were inoculated in blood culture media broth and bacterial growth was identified. Overall, eight of 89 aqueous samples (9%) obtained using a cannula at the beginning of surgery were culture-positive. Similarly, six of 41 aqueous samples (15%) obtained through a needle through clear cornea at the beginning of surgery showed contamination. At the conclusion of surgery, nine of 112 samples (8%) showed positive cultures. There was no difference in the aqueous contamination rates between the control and study groups. Despite the use of a needle to obtain aqueous fluid at the beginning of surgery before creating a paracentesis, the aqueous contamination rate remained higher than that found at the conclusion of surgery. A 3-day application of topical ofloxacin before surgery did not reduce the anterior chamber aqueous contamination rate relative to a 1-hour application.