Bacterial Flora - A Potential Source of Endophthalmitis after Cataract Surgery
Yong Rongrungruang MD*, Jutalai Tantaterdthum MD**, Yuwadee Tantiwattanapibul RN***, Siriporn Sripalakij MSc***, Somwang Danchaivijitr MD*
Affiliation : *Department of Medicine,**Department of Ophthalmology, ***Center for Nosocomial Infection Control, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objectives : To study bacteria from eye lids and conjunctival sac of patients undergoing cataract surgery
before and after the application of antiseptics.
Materials and Methods : Patients undergoing elective cataract extraction in one university hospital were
randomly enrolled. Cultures for bacteria and candida were done by swabbing the eye lids before and after
cleaning with 4% chlorhexidine gluconate. Subsequently 7% povidone iodine was applied on eye lids and
conjunctival sacs. Cultures of specimens from eye lids and conjunctival sac were taken after the application of
7% povidone iodine and at the end of the operation.
Results : Fifty-one patients were enrolled. Positive cultures were found in 90.2% and 82.4% before and after
cleaning the face with 4% chlorhexidine. After topical application of 10% povidone iodine, only 19.6% had
positive cultures from eye lids and conjunctival sac; a significant reduction (p=0.001).At the end of the
operation, positive cultures were found from eye lids in 10 patients and from the conjunctival sac in 4 patients.
Isolates were skin flora and candida species in 2 patients. None of the patients had endophthalmitis.
Conclusion : Cleaning eye lids with 4% chlorhexidine followed by applying 10% povidone iodine was
effective in decreasing skin flora in cataract surgery. The organisms were not completely eliminated. Post-
operative follow-up to detect infectious complications is warranted.
Keywords : Bacterial Flora, Endophthalmitis, Cataract surgery
