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Postoperative contamination after using vancomycin and gentamicin during phacoemulsification
J F Ferro1, M de-Pablos, M J Logroño
1Department of Ophthalmology, Hospital of Txagorritxu, Vitoria, Spain. jferro@redestb.es
Objective:
To investigate if the addition of vancomycin and gentamicin to the irrigating solutions during phacoemulsification with lens implantation reduces the incidence of positive postoperative intraocular cultures.
Design:
Two-part double-masked, placebo-controlled, randomized clinical trial.
Patients:
In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 10 eyes) and 2 hours after surgery (in 10 eyes) in patients treated with antibiotics. In the primary study, 120 eyes underwent uncomplicated surgery. The treatment group and the placebo group were composed of 60 eyes each.
Intervention:
The treatment group received vancomycin, 20 micrograms/mL, and gentamicin, 8 micrograms/mL, in the irrigating fluid. The placebo group received only irrigating fluid. All patients in the primary study underwent anterior chamber aspiration following surgery, and culturing was performed 2 hours later.
Main Outcome Measure:
Identification and quantification of positive cultures in thioglycolate broth and chocolate agar.
Results:
In the preliminary study, the half-life of both intraocular antibiotics was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in 3 specimens (5.0%) in the antibiotic-treated group and in 7 specimens (12.0%) in the placebo group.
Conclusions:
Although we found a higher rate of positive postoperative cultures in the placebo group (odds ratio = 2.51), 2 hours of contact between the antibiotic solution and bacteria did not produce results that reached statistical significance (P =.18) to support adding vancomycin and gentamicin to the irrigating solutions during phacoemulsification. Further studies are needed to evaluate the clinical implications of using antibiotics in irrigating solutions.
Insights
Adding vancomycin and gentamicin to irrigating solutions during phacoemulsification did not significantly reduce positive postoperative intraocular cultures. While the placebo group had more positive cultures, the difference lacked statistical significance, suggesting further research is needed.
Area of Science:
- Ophthalmology
- Infectious Disease
- Surgical Innovation
Background:
- Postoperative endophthalmitis remains a concern after cataract surgery.
- Intraocular antibiotics are explored to prevent infection.
- Phacoemulsification with lens implantation is a common surgical procedure.
Purpose of the Study:
- To determine if adding vancomycin and gentamicin to irrigating solutions during phacoemulsification reduces positive postoperative intraocular cultures.
- To assess the efficacy of intraocular antibiotics in preventing bacterial contamination during cataract surgery.
Main Methods:
- A two-part, double-masked, placebo-controlled, randomized clinical trial was conducted.
- The primary study involved 120 eyes undergoing uncomplicated phacoemulsification with lens implantation.
- Patients received either irrigating fluid with vancomycin and gentamicin or placebo, followed by anterior chamber aspiration and culturing.
Main Results:
- Intraocular antibiotics had a half-life of less than 2 hours.
- Positive cultures were found in 5.0% of the antibiotic-treated group versus 12.0% in the placebo group.
- The observed difference in positive cultures did not reach statistical significance (P =.18).
Conclusions:
- The addition of vancomycin and gentamicin to irrigating solutions during phacoemulsification did not significantly decrease positive postoperative intraocular cultures.
- The study did not provide statistically significant evidence to support routine use of these antibiotics in irrigating solutions.
- Further research is recommended to explore the clinical implications and optimal use of antibiotics in ophthalmic surgical irrigation.