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Impressum
PCR-detection of bacterial anterior chamber contamination after small-incision cataract surgery: foldable IOL-insertion using folding forceps versus injector systems: a prospective, randomized study
Schmitz K., 1König B., Behrens-Baumann W.
University-Eye-Department, Magdeburg; 1Institute of Medical Microbiology, University of Magdeburg, Germany
Objective: Does the use of injector systems further reduce the
risk of bacterial anterior chamber contamination during foldable IOL-insertion
in small-incision cataract surgery as compared to the use of folding forceps?
Methods: 50 eyes of cataract patients were randomly assigned to
two groups. In all eyes, phacoemulsification was performed via a 3.5 mm
scleral tunnel incision and a silicone-IOL (Allergan SI 30) was implanted
into the capsular bag. In 25 eyes, IOL-insertion was achieved using folding
forceps, in the other 25 using an injector system (Unfolder®). At
the end of surgery, a sample of app. 0.2 ml anterior chamber fluid were
withdrawn via paracentesis and at the same time another sample directly
from the irrigation line to serve as control. The collected samples were
deep-frozen immediately and later tested for the presence of bacterial
DNA using a quantitative polymerase chain reaction (PCR; LightCycler).
Results: 95 % of all samples, anterior chamber samples as well
as samples from the irrigation line, were positive for bacterial DNA (16S-rRNAgene)
using a sensitive quantitative PCR-method. We detected 102 to 106 copies
per sample. There was no difference in DNA load between the two patient
groups.
Conclusion: Postoperative endophthalmitis is the most severe complication
after intraocular surgery with an incidence of 0.05 to 0.1 % after cataract
surgery. Thanks to the introduction of small-incision surgery and the
use of foldable IOLs, almost all steps of the surgery are performed in
a "closed" system. Only during IOL-insertion there is a negative
pressure gradient from extraocular to intraocular. In our study, the use
of injector systems did not show an advantage regarding the objective
of the study. However, the results clearly demonstrate that contamination
of the operation field with bacterial DNA cannot be ruled out during cataract
surgery.