Prospective evaluation of external ocular microbial growth and aqueous humor contamination during cataract surgery.

PURPOSE: To analyze the route of aqueous humor contamination leading to the development of postoperative endophthalmitis. SETTING: Department of Ophthalmology, University of Helsinki, Finland. METHODS: Forty-nine eyes of 49 patients (31 having phacoemulsification and 18 extracapsular cataract extraction [ECCE]) participated in the study. Four bacterial cultures were taken: preoperative conjunctival swab, lid margin culture, intraoperative lacrimal lake sample, and immediate postoperative anterior chamber fluid sample. RESULTS: Preoperative lid margin cultures were positive in 59.2% of eyes, conjunctival cultures in 69.4%, and lacrimal lake cultures in 24.9%. Four aqueous humor samples (8.2%) showed bacterial growth in the anterior chamber aspirate: 3 in the phacoemulsification and 1 in the ECCE group. The bacteria isolated in this study, Staphylococcus epidermidis and Propionibacterium acnes (2 positive isolates each) were sensitive to the preoperative topical antibiotics used. No aqueous humor sample or any from other locations showed gram-negative microbe growth. The most frequently recovered microbes in all samples collected from the 3 other sources were S epidermidis and other coagulase-negative staphylococcus species, followed by P acnes and other propionibacterium species. Staphylococcus aureus, and diptheroids. CONCLUSION: The ocular surface significantly contributed to the transmission of microbes into the eye during cataract surgery. These microbes could not be eradicated by topical preoperative antibiotics. However, no patient developed postoperative endophthalmitis. Natural defense mechanisms appear to fend off a minor inoculum with these microbes of relatively low pathogenicity.

Early rehabilitation after small incision cataract surgery.

BACKGROUND: The use of smaller cataract incision is thought to induce less astigmatism, resulting in a more stable refraction and more stable wound. METHODS: We have analyzed the early astigmatic changes and rehabilitation in 20 eyes of 16 patients operated with advanced phacoemulsification techniques. The patients operated with small-incision surgery (incision 4.0 mm) were compared to those with large-incision surgery (incision 7.5 mm). Keratometric values and visual acuity data were evaluated up to 6 months postoperatively. RESULTS: Less initial induced astigmatism was demonstrated at day 7 postoperatively with a 4.0-millimeter incision (0.1 +/- 0.53 D) compared with a 7.5-millimeter incision (1.90 +/- 1.97). Similar but not statistically significant changes were seen at days 1 and 30 postoperatively. Visual rehabilitation was also faster in the small-incision group and 70% of the eyes gave uncorrected visual acuity of 20/40 or better in this group as early as the first postoperative day. Only 11% of the eyes showed that uncorrected visual acuity after large-incision surgery at first postoperative day. CONCLUSION: The low amount of induced cylinder, rapid stabilization of the wound, and faster visual rehabilitation confirms the advantage of small-incision cataract surgery to large-incision surgery.

Economic evaluation of cataract surgery: a comparison between IOL and non-IOL techniques.

Using a sample of 116 patients, 53 of whom had undergone cataract extraction without IOL implantation, and 63 of whom had been treated by IOL implantation, a retrospective evaluation of differences in economic effects was performed. The use of non-IOL technique was cheaper for the hospital, but the overall costs for society were soon higher, mainly as a result of the significantly higher costs of obtaining contact lenses and spectacles in the non-IOL group. The longer we expect cataract surgery patients to live post-operatively the greater will be the difference in favour of using the IOL technique. The estimated annual savings to society for every 875 patients operated would be from FIM 5 million to FIM 26.5 million if non-IOL technique was used and from FIM 10.5 million to FIM 28.5 million with IOL surgery. Cataract surgery, and especially with IOL technique, seems to be an operation resulting in substantial savings to society.

Visual results and social rehabilitation after cataract surgery. A retrospective comparison of the effect of non-IOL and IOL surgery.

This report examines the changes that occurred in the post-operative visual and social function of patients with cataract when the hospital responsible for cataract treatment (roughly 1000 cataract extractions per year) shifted from non-IOL to IOL techniques. Visual function and vision-dependent social performance were compared retrospectively in 116 patients, 53 of whom had undergone cataract extraction without IOL implantation, and 63 of whom had been treated by IOL implantation. Patients with no IOL had the possibility of using extended-wear contact lenses if unable to tolerate aphakic spectacles. Visual results and social rehabilitation were good with both techniques, and there was no significant difference in vision-dependent social performance between the groups. The quality of vision and patient satisfaction with surgery were better in IOL patients. It appears that, once vision is restored by surgery and contact lenses are available, post-operative function in patients is determined by factors other than the type of cataract surgery. However, the shift to IOL surgery brings about improved quality of vision and patient satisfaction.

Incidence of choroidal malignant melanoma in Finland in the years 1973-1980.

Recent reports concerning the incidence of choroidal and ciliary body melanomas have raised a suspicion of an increase of this malignancy in the developed countries. The rapid rise in the incidence of melanoma of the skin is well known. This study covers the incidence of choroidal and ciliary body melanomas in Finland over the years 1973-1980. A total of 382 cases of intraocular malignant tumours were reported to the Finnish Cancer Registry. 285 choroidal and ciliary body melanomas were found. The age-specific incidences showed a steep rise from the age of 30 to the age of 70. The peak incidence was in the age-group 70 and over. There was only one case, a girl 12 of age, in the age-group 15 years and younger. The age adjusted incidences showed no significant increase during the study period. The age-specific incidence showed no significant difference compared to a previous study. Sex, laterality or latitude were not found to be risk factors.