Clear corneal wound infection after phacoemulsification

To evaluate clear corneal wound infections after phacoemulsification.

The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and signs after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, culture and antibiotic sensitivity results, treatment regimen, and outcome.

The median onset of signs and symptoms after surgery was 10 days (range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphylococcus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphylococcus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patient. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture-positive cases, the isolated microorganisms were resistant to the perioperative prophylactic antibiotics (fluoroquinolones and tobramycin) that were used. No possible risk factors were noted except use of topical steroids 4 times a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiotic therapy. One of the patients required lamellar keratectomy and conjunctival flap for complete healing. In 4 of the 7 cases, best-corrected visual acuity at the last follow-up visit was better than 20/40.

Clear corneal wound infection after phacoemulsification is a serious complication of cataract surgery. Infections are caused by gram-positive organisms sensitive to bacitracin and the combination of trimethoprim-sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinolones.