Patients showed an appreciable degree of pupillary motion during measurement at all levels of illumination; the motion was largest under low mesopic illumination. The 2 pupils were rarely identical. Multiple-measurement binocular pupillometry is better than single monocular measurement to gain a precise description of pupil behavior before refractive surgery.
The incidence of perioperative and postoperative complications was comparable with those reported in other series. Factors that increased the risk of PCR + VL included pseudoexfoliation, diabetes mellitus, and a traumatic etiology. Previous glaucoma surgery and axial myopia of greater than 26.0 mm did not increase the PCR + VL risk. Loose or broken corneal sutures was a common finding that could be reduced substantially by planned suture removal.
Using an open-loop, flexible, anterior chamber lens for secondary implantation is still an acceptable way to treat aphakia. The poor reputation of these lenses is undeserved.
Background-Anterior chamber aspirates on completion of extracapsular cataract surgery contain significant numbers of organisms, particularly coagulase negative staphylococci, an important cause of endophthalmitis. Methods-Culture rates were compared in 50 patients after phacoemulsification surgery, which allows the possible benefits of a small, self sealing wound and maintenance of positive intraocular pressure, with a similar number of extracapsular cases.Results-A culture positive rate of 20% and 24% respectively was found, an insignificant difference. Conclusion-Small incision surgery has no proved advantage over extracapsular surgery in terms of reducing the intraoperative bacterial inoculum. The significance of this result in terms of causation of endophthalmitis is discussed. (Br_J Ophthalmol 1995; 79: 878-880) Recent studies by this and other groups have confirmed that the anterior chambers of eyes following extracapsular cataract surgery are frequently contaminated by small numbers of bacteria.1-3 Contamination rates of 29-43% have been reported. This group found a rate of 24% in two groups of 40 patients, and that preoperative topical antibiotics (norfloxacin, MSD) had no effect on culture rates. The organisms found are in small numbers (10-40 colony forming units/ml), and are most commonly skin commensals, especially coagulase negative staphylococci. These organisms are a leading cause of endophthalmitis. It has been assumed that one route of entry is from fluid circulating in the conjunctival sac at the time of surgery, but although both povidone-iodine4 5 and topical antibiotics6 are effective in reducing skin commensals (as shown by conjunctival swabs), efforts to sterilise the conjunctival sac preoperatively are only one approach to the problem, and according to our previous work may not be reducing intraocular contamination.Phacoemulsification allows a smaller wound, and is usually combined with a scleral tunnel which has a degree of self sealing properties. The eye is, therefore, less accessible to contamination from any external source, be it conjunctiva, lashes, or air. Studies of intraoperative pressure changes do suggest that positive intraocular pressure is easier to maintain with this type of wound,7 and this, together with the small wound, should minimise influx of conjunctival fluid from the wound margins.This study has been designed to examine the contamination of anterior chambers of eyes at the completion of phacoemulsification cataract surgery, and to compare this with previous observations from extracapsular surgery. Materials and methodsFifty patients undergoing routine phacoemulsification cataract surgery were recruited into this prospective study. Written consent for aqueous samples to be taken was obtained. Exclusion criteria included: (a) history or evidence of previous surgery or penetrating injury to the eye; (b) local or systemic infection at the time of surgery; (c) perioperative complications such as posterior capsule rupture or conversion to extracapsular surger...
Eighty patients undergoing routine standardised extracapsular cataract surgery with lens implantation were divided randomly into two groups in a prospective double blind study comparing effects of preoperative norfloxacin eyedrops with placebo on bacterial contamination of anterior chamber aspirates after surgery. Pathogenic organisms were identified from 19 (24%) Patients were randomised into two groups:group I patients were prescribed norfloxacin eyedrops every 2 hours for at least 6 hours and a maximum of 12 hours preoperatively; group II patients were prescribed normal saline eyedrops every 2 hours. In theatre a meticulous aseptic preparation was performed on all patients in an identical fashion using 7 5% povidone iodine solution applied to the skin around the eye and conjunctival fornices. The patient's face was then draped with a sterile cloth towel and excess povidone iodine was wiped away with sterile ribbon gauze. The eyelids were opened and clear adhesive steridrape was applied over the lids. Thereafter a standardised ECCE using an envelope technique with posterior chamber lens implantation was performed. In all cases a corneal section was used and all viscoelastic was removed with the anterior chamber being reformed with balanced salt solution before closure of the final corneal suture. After wound closure a sterile 27 gauge cannula attached to a tuberculin syringe was placed in the anterior chamber and 0 2 ml of fluid was aspirated. One hundred milligrams of subconjunctival cefuroxime was injected into the inferior fornix at the conclusion of each operation.Aspirates were inoculated immediately in equal portions onto a chocolate agar plate and into brain-heart infusion broth. The cultures were sealed in the operating room and transported immediately to the university department of clinical microbiology. Chocolate agar plates were incubated at 37°C in air with 5% carbon dioxide for 5 days and fluid media were incubated at 37°C for 48 hours then subcultured onto chocolate agar plates incubated aerobically and anaerobically.
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