PROPHYLACTIC CONJUNCTIVAL SMEARS IN PATIENTS WITH AND WITHOUT RISK FACTORS BEFORE INTRAOCULAR SURGERIES

97th DOG Annual Meeting 1999

P536
PROPHYLACTIC CONJUNCTIVAL SMEARS IN PATIENTS WITH AND WITHOUT RISK FACTORS BEFORE INTRAOCULAR SURGERIES

S. J. Fröhlich, H. Miño de Kaspar, U. C. Schaller, M. Bengisu, V. Klauß

Kind and size of microbial colonisation of the anterior segments directly before intraocular interventions can influence the risk of postoperative endophthalmitis.

Purpose: It is known that postoperative endophthalmitis often shows the same spectrum of aetiological agents like preoperative smears. However, until now it is not well understood, in which groups of patients prophylactic smears are necessary. This study should characterize the importance of prophylactic smears in patients with and without risk factors.

Methods: From 1994 to 1998 at the University Eye Hospital of Munich preoperative prophylactic conjunctival smears were performed in 1474 residential patients. Among them were 282 patients without risk factors, 503 patients with local risk factors (e.g. mild infections of the anterior segments), 545 patients with systemic risk factors (e.g. diabetics, patients with immune deficiencies) and 144 patients with both local and systemic risk factors. Bacteria were identified microbiologically and chemically according to our standard methods. As in conjunctical smears a normal flora exists, smears were defined as positive when agar media showed more than (>) 10 colonies coagulase-negative Staphylococci, > 3 colonies Staphylococcus aureus, > 1 colony gramnegative Enterobacteria or when opacity in liquid media was detectable.

Results: In patients without risk factors the prophylactic smears showed a positive result in only 5%. Bacterial growth was significantly more often positive in patients with risk factors: 23% in case of local risk factors, 12% in case of systemic risk factors and 15% in case of combined local and systemic risk factors.

Conclusion: In patients without any risk factors a prophylactic smear does not need to be carried out. However, a preoperative smear is important in patients with local and/or systemic risk factors. In case of positive bacterial growth, surgery should be postponed until the local findings after antibiotic therapy are negative. Such reduction of bacterial colonisation at the external eye could lower the frequency of postoperative endophthalmitis.

University Eye Hospital, Ludwig-Maximilians-University, Mathildenstr. 8, D-80336 Munich/Germany

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