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Peroperative microbial contamination of anterior chamber aspirates during extracapsular cataract extraction and
B Beigi1, W Westlake, E Mangelschots
1West Of England Eye Unit, Royal Devon and Exeter Hospital.
Background:
The normal conjunctival flora is one of the main sources of intraocular contamination during cataract surgery. The theory that the positive anterior chamber (AC) pressure during phacoemulsification (phaco), and the smaller wound utilised, might reduce the rate of contamination was studied.
Methods:
The peroperative AC aspirates of 210 consecutive patients undergoing cataract surgery were assessed. In group 1, 100 patients underwent a standard extracapsular cataract extraction (ECCE). In group 2, 110 patients underwent phacoemulsification of the crystal-line lens through a scleral tunnel. AC aspirates from the Simcoe irrigation/aspiration cannula (group 1) and phaco probe (group 2) were collected and microbiological studies performed after direct and enrichment cultures.
Results:
There were 29 (29%) positives in the ECCE group compared with 22 (20%) positive cultures from AC aspirates in the phaco group. Coagulase negative staphylococcus (CNS) was the commonest contaminant in both groups.
Conclusion:
Although there was a higher rate of AC contamination during ECCE, the difference was not statistically significant (p > 0.10, chi 2 = 2.31).
Insights
Phacoemulsification (phaco) may reduce anterior chamber (AC) contamination during cataract surgery compared to extracapsular cataract extraction (ECCE), though the difference was not statistically significant. Coagulase-negative staphylococcus was the most common contaminant in both procedures.
Area of Science:
- Ophthalmology
- Microbiology
- Surgical Safety
Background:
- The conjunctival flora is a primary source of intraocular contamination during cataract surgery.
- Phacoemulsification (phaco) utilizes a smaller incision and maintains positive anterior chamber (AC) pressure, potentially reducing contamination risk compared to extracapsular cataract extraction (ECCE).
Purpose of the Study:
- To investigate whether phacoemulsification reduces the rate of anterior chamber contamination during cataract surgery compared to ECCE.
Main Methods:
- A prospective study assessed peroperative AC aspirates from 210 patients undergoing cataract surgery.
- Group 1 (100 patients) underwent ECCE with Simcoe irrigation/aspiration.
- Group 2 (110 patients) underwent phacoemulsification through a scleral tunnel using a phaco probe.
Main Results:
- 29% of ECCE patients had positive AC cultures versus 20% of phacoemulsification patients.
- Coagulase-negative staphylococcus (CNS) was the most frequent contaminant in both groups.
- The observed difference in contamination rates between ECCE and phacoemulsification was not statistically significant (p > 0.10).
Conclusions:
- While ECCE showed a higher rate of AC contamination, the difference was not statistically significant.
- Both ECCE and phacoemulsification carry a risk of anterior chamber contamination.
- Further research may be needed to definitively establish the impact of surgical technique on contamination rates.