Fifty-two unilaterally enucleated patients were studied for symptoms, signs, and actual presence of bacteria in the socket and fellow eye. The majority (85%) of asymptomatic sockets were found to have a mixed culture of pathogenic organisms. Sockets had a significantly (P = .001) greater frequency of pathogenic organisms than the fellow eye. Cross contamination does not appear frequently but is a definite possibility. We recommend culture and treatment of the asymptomatic socket before surgery on the remaining eye.
Indigenous ocular flora has been presumed to be a source of infectious organisms in postoperative bacterial endophthalmitis. While bacteria have been recovered from the anterior chamber at the time of cataract wound closure in a significant percentage of cases, and bacteria from the vitreous of endophthalmitis cases have appeared genetically to be very similar to bacteria recovered from the adnexa and/or nares at the time of vitrectomy for endophthalmitis, no study has examined the relationship between organisms isolated from the eyelid and conjunctiva, and organisms recovered from the aqueous humor at the time of wound closure. This study examined 59 eyes undergoing cataract and other intraocular surgeries. Cultures of the eyelids and conjunctiva were taken before and after routine preparation with povidone-iodine solution. Cultures also were taken of the aqueous humor at the time of incision into the anterior chamber and at the time of wound closure. No organisms grew from aqueous humor samples taken at the time of incision. However, 13 eyes (22%) grew gram-positive organisms from samples taken at the time of wound closure. Eight of the 13 eyes (62%) had organisms with identical typing and antibiotic sensitivities to organisms isolated from the eyelids and conjunctiva before or after disinfection. This study suggests that a significant number of cases had inoperative bacterial contamination of the aqueous humor by the time of wound closure and that organisms from the eyelids and conjunctiva are an important source of contamination in these cases.
We studied events leading to the development of posttraumatic endophthalmitis by examining the significance of 15 factors on microbial contamination of injured eyes.
A prospective study was done of 30 ruptured globes in patients admitted to an urban medical center. Cultures were taken from the conjunctiva before and after preoperative disinfection and from the anterior chamber at the beginning and end of wound repair. Twenty-five of 30 patients received a three-day regimen of intravenous antibiotics that were begun before surgery.
Anterior chamber samples grew microorganisms in ten (33%) of 30 eyes, with positive cultures recovered from specimens taken at the beginning of wound repair in eight eyes and at the end of wound repair in six eyes. Contamination with indigenous flora may have occurred at the time of injury in one eye and during repair in another eye. Microbes recovered included Staphylococcus, Corynebacterium, and Aspergillus species. No patient developed endophthalmitis. Of the 15 factors studied, only intravenous antibiotics significantly decreased the incidence of positive anterior chamber cultures in eyes treated before wound repair compared with eyes not receiving such therapy (P = .002).
Despite the frequency of anterior chamber microbial contamination during injury or repair of the wound, with our treatment protocol and the presence of physiologic mechanisms to reduce intraocular microbes, no eyes developed clinical endophthalmitis. With our limited sample size only intravenous antibiotic therapy was found significantly to reduce anterior chamber microorganisms at the time of surgical repair, supporting their prophylactic use against the development of posttraumatic endophthalmitis.
Corneal scarring secondary to inactive phlyctenular keratoconjunctivitis (PKC) is a significant cause of decreased vision in Alaskan Natives. The results of primary penetrating keratoplasty for such cases at the Alaska Native Medical Center form the basis of this report. Eighteen cases met the criteria established for this study. Fourteen (79 percent) had clear grafts at least six months after surgery (average follow-up: 46 months). Of the twelve grafts performed using 10-0 nylon and the operating microscope, 11 (92 percent) were clear. Twelve of the 14 persons with clear grafts had improved vision of at least two lines on the Snellen chart. On the basis of this report, penetrating keratoplasty for corneal scarring due to PKC seems to have a favorable prognosis.