Estudio comparativo de la eficacia de diversas modalidades terapéuticas en pacientes con blefaritis crónica / Comparative study of the efficacy of different treatment options in patients with chronic blepharitis

OBJETIVO: Comparar la eficacia de 3 modalidades de tratamiento en pacientes con blefaritis crónica. METODOLOGÍA: Se realizó un estudio experimental, aleatorizado y controlado en 45 pacientes (sexo femenino: 67%; edad media: 40,5 años) con diagnóstico de blefaritis crónica para comparar la eficacia de 3 modalidades de tratamiento. Grupo 1: higiene palpebral con champú neutro 3 veces/día; grupo 2: higiene palpebral con champú neutro y gel tópico de metronidazol al 0,75% 2 veces/día; grupo 3: higiene palpebral con champú neutro y pomada antibiótica de neomicina al 3,5% y polimixina al 10% con dexametasona al 0,5% 3 veces/día. Los síntomas y signos fueron valorados asignándoles puntuaciones entre 0: sin síntomas ni signos; 1: síntomas o signos leves; 2: síntomas o signos moderados y 3: síntomas o signos severos. RESULTADOS: En los 3 grupos de tratamiento se observó mejora significativa de los signos y síntomas. Mientras que los grupos 1 y 2 presentaron una mayor mejoría en todas las variables estudiadas (p < 0,05), el grupo 3 no presentó mejoría clínica para comezón (p = 0,16), ojo seco (p = 0,29), caída de pestañas (p = 0,16) ni eritema en el borde palpebral (p = 0,29). CONCLUSIÓN: La higiene palpebral con champú neutro y el uso combinado de champú neutro con gel de metronidazol reportaron mejores resultados que la higiene palpebral con champú neutro y pomada antibiótica de neomicina y polimixina con dexametasona

OBJECTIVE: To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY: An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS: A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P < .05), Group 3 showed no clinical improvement for itching (P = .16), dry eye (P = .29), eyelashes falling (P=.16), and erythema at the eyelid margin (P = .29). CONCLUSIONS: Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

OBJECTIVE: To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY: An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS: A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). CONCLUSIONS: Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone.

Eficacia de la aplicación tópica de 0, 3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas / Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction

Objetivo: Determinar la eficacia de la ciprofloxacina tópica al 0,3% en la reducción de la biota conjuntival en pacientes operados de cataratas. Pacientes y métodos: Estudio experimental, prospectivo, aleatorizado, controlado a simple ciego. Cuarenta y seis ojos de 46 pacientes fueron distribuidos al azar en dos grupos: el grupo de estudio (n = 23) recibió ciprofloxacina al 0,3% un día antes de la cirugía a razón de una gota cada 6 h y, luego, en el día de la cirugía, una gota cada 15 min, empezando una hora antes de la cirugía hasta completar tres dosis; el grupo control (n = 23) no recibió antibiótico; en ambos grupos para el campo quirúrgico se utilizó iodopovidona al 10%. Se tomaron muestras de la conjuntiva en cuatro momentos diferentes, cultivadas en medios sólidos (agar chocolate, agar sangre) y en caldo de enriquecimiento (tioglicolato). Además se obtuvieron muestras de humor acuoso que fueron cultivadas en tioglicolato. La presencia de bacterias fue identificada cuantitativa y cualitativamente y la frecuencia de contaminación fue medida considerando el desarrollo de microorganismos en los medios de cultivo tanto líquido como sólido, y se contabilizaron los números de colonias (UFC) en el sólido. Resultados: Antes de la administración de ciprofloxacina al 0,3% se obtuvieron cultivos positivos en el 82,6 y 78,3% de los pacientes en los grupos de estudio y control, respectivamente. La administración de ciprofloxacina al 0,3% redujo significativamente las UFC en comparación con el grupo control (p < 0,05); inmediatamente después del uso de la iodopovidona el porcentaje de pacientes con cultivo positivo disminuyó a 21,7% en el grupo de estudio y a 8,7% en el grupo control; al final de la cirugía este porcentaje fue de 26 y 30,4%, respectivamente. El germen más frecuente fue el estafilococo coagulasa-negativo (66,7%) (AU)

Conclusión: La administración de ciprofloxacina al 0,3% reduce la carga bacteriana conjuntival en el período preoperatorio, pero no la erradica de forma significativa. La administración de iodopovidona erradica la biota conjuntival en el 50-70% de los pacientes operados de cataratas (AU)

Objective: To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. Patients and methods: Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n = 23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15 minutes starting one hour before surgery until 3 doses were completed. The control group (n = 23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. Results: Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P < 0.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%) (AU)

Conclusion: The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery (AU)

[Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction]. / Eficacia de la aplicación tópica de 0,3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas.

OBJECTIVE: To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. PATIENTS AND METHODS: Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. RESULTS: Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%). CONCLUSION: The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.

Contaminación microbiana de colirios utilizados por pacientes en la consulta externa de oftalmología / Microbial contamination of eye drops used by patients in an outpatient clinic of ophthalmology

Los colirios contaminados representan una causa potencial de infección ocular prevenible. Como toda medicación terapéutica tópica, los colirios deben estar libres de agentes contaminantes. La frecuencia de contaminación varía entre 0,07% y 35,6% en los estudios publicados; no existiendo estudios publicados sobre este tema en nuestro país. Este estudio tiene como objetivo determinar la frecuencia de contaminación de las gotas oftálmicas utilizadas por pacientes que consultan en la Fundación Visión en Asunción, Paraguay. A todos los pacientes que acudieron a la consulta externa en el Servicio de Oftalmología de la Fundación Visión, de agosto de 2007 a julio de 2008 se les solicitó que entregaran sus envases de gotas oftálmicas que estuvieron utilizando por dos o más semanas, además se registraron sus datos demográficos y relacionados al uso del colirio. Los envases fueron enviados al Instituto de Investigaciones en Ciencias de la Salud (IICS), de manera que la medicación restante en el interior de los mismos fuera cultivada en los medios microbiológicos convencionales. De los 73 envases recolectados, 8 (11%) presentaron cultivos positivos, siendo los gérmenes aislados Estafilococo coagulasa negativo, Propionibacterium acnes, Serratia marcescens, Corynebacterium sp y Alcaligenes faecalis, además del hongo oportunista Aspergillus fumigatus. La contaminación de los colirios utilizados por estos pacientes es relevante. Estos resultados coinciden con reportes de otros países y señala la importancia de dar orientaciones a los pacientes en cuanto al modo de utilización, almacenamiento y tiempo de recambio de los colirios por parte de los oftalmólogos.

[Persistent contact lens-associated keratitis]. / Persistierende kontaktlinsenassoziierte Keratitis.

A 43-year-old woman presented with a 2-month history of contact lens-associated keratitis and corneal ulceration on the left eye. Without having isolated the pathogenic agent, a calculated anti-infective and anti-inflammatory therapy had already been administered with no signs of improvement. Filamentous fungi (Acremonium sp) were found in the scraping material and the contact lens solution. A keratoplasty à chaud was necessary despite immediate initiation of pathogen-specific therapy. Early identification of the pathogen via corneal debridement and culturing are standard procedures in order to initiate a specific therapy and prevent ulceration which can threaten the visual outcome.

In vitro antibiotic susceptibility of preoperative normal conjunctival bacteria.

PURPOSE: To determine the antibiotic susceptibility of preoperative conjunctival bacterial flora. METHODS: Antibiotic susceptibility of conjunctival bacterial strains isolated from 142 patients undergoing intraocular surgery was determined using the Kirby-Bauer disc diffusion technique. chi(2) statistical analysis was performed. RESULTS: Among the 116 bacteria isolated, 95 (82%) were coagulase-negative staphylococci (CNS). Most (>75%) of them were susceptible to vancomycin, minocycline, aminoglycosides, gatifloxacin, levofloxacin, and moxifloxacin. Approximately one-half of CNS was resistant to erythromycin and azithromycin. Over 90% of streptococci were susceptible to levofloxacin, moxifloxacin, and gatifloxacin. RESULTS: Fluoroquinolones, specifically gatifloxacin, levofloxacin, and moxifloxacin continue to provide broad-spectrum coverage against common conjunctival bacterial flora.

Frecuencia y sensibilidad antimicrobiana de agentes etiológicos de dacriocistitis / Frequency and antimicrobial sensibility of etiological agents of dacriocystitis

La dacriocistitis representa la infección más frecuente del sistema lagrimal. El estudio microbiológico de las dacriocistitis es importante para la adecuada selección de los antibióticos. El objetivo del estudio es determinar la frecuencia y sensibilidad antimicrobiana de los agentes causantes de dacriocistitis en pacientes que acudieron a la Cátedra de Oftalmología del Hospital de Clínicas de mayo de 1998 a abril de 2007. Los pacientes no recibieron antibióticos por lo menos por una semana antes de la toma de muestra, que fueron tomadas por aspiración del contenido del saco lagrimal por el canalículo inferior o punción directa del saco lagrimal, y cultivadas en aerobiosis y anaerobiosis siguiendo métodos convencionales. De 41 pacientes (23 adultos y 18 niños), 30 (73,1%) presentaron cultivos positivos; 16 (53.4%) monomicrobianos y 14 (46,6%) polimicrobianos. Se aislaron 51 microorganismos, 37 en adultos y 14 en niños. El 54% de los microorganismos aislados en muestras de adultos correspondió a bacilos gramnegativos (enterobacterias, Haemophilus sp, anaerobios, y bacilos gramnegativos no fermentadores); 41% a cocos grampositivos (Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, y estafilococo coagulasa negativo); el 72% de los micro-organismos aislados en niños correspondió a cocos grampositivos (Staphylococcus aureus y Streptococcus pneumoniae), y en una muestra se aisló Candida sp. La sensibilidad del Streptococcus pneumoniae a la penicilina y la del Staphylococcus aureus a la meticilina fue de 100%. Los microorganismos aislados presentaron buena sensibilidad a los antimicrobianos, pero por la gran variedad de microorganismos y la naturaleza polimicrobiana de los cultivos se debería ampliar el esquema inicial de tratamiento y de la profilaxis de la dacriocistorrinostomía y otros procedimientos intraoculares. Una opción es el uso de aminopenicilinas con un inhibidor de betalactamasa; asociado con colirio de tobramicina en niños y ciprofloxacina en adultos.

Dacryocystitis is the most frequent infection of the lacrimal sac. The microbiological evaluation of dacryocystitis is important to make an adequate choice of antibiotics. The objective of this study is to determine the frequency and antibiotic susceptibility of the etiological agents of dacryocystitis in patients attending the Ophthalmology Department of the Teaching Hospital of the National University of Asunción, Paraguay from May 1998 to April 2007. All patients were antibiotic-free for at least one week prior to sampling. Samples were taken by aspiration of the lacrimal sac obtained via canalicular reflux or incision of the lacrimal sac and cultured aerobically and anaerobically following standard methods. Out of 41 patients (23 adults and 18 children), 30 (73.1%) showed positive cultures, 16 (53.4%) of them were pure and 14 (46.6%) mixed cultures, yielding 51 microorganisms. Of the 37 microorganisms 54% were isolated in adults and corresponded to gram negative rods (enterobacterias, Haemophilus sp, anaerobic and non fermenting gram negative rods) while 41% to gram positive cocci: (Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, coagulase negative Staphylococcus). In children, 72% of the micro-organisms isolated were gram positive cocci (Staphylococcus aureus and Streptococcus pneumoniae) and Candida sp was found in one sample. The susceptibility patterns of the Streptococcus pneumoniae to penicillin and Staphylococcus aureus to methicillin were 100%. All isolates showed high susceptibilities to the tested antibiotics. However, due to the great variety of species and the polymicrobial nature of the cultures, the initial scheme and prophylaxis of the dacryocystorhinostomy and other intraocular procedures should be expanded. One option is the use of aminopenicillins with a betalactamase inhibitor associated with tobramycin in children and ciprofloxacin in adults.

Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora.

PURPOSE: To compare efficacy of a 1-day versus 3-day application of topical levofloxacin in reducing ocular surface bacteria. METHODS: In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3. RESULTS: A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000). CONCLUSIONS: The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.

Actividad in vitro de fluoroquinolonas en bacilos gramnegativos aislados deurocultivos de pacientes ambulatorios / In vitro activity of fluoroquinolones in gramnegative rods isolated from ambulatory patients urocultures

Las fluoroquinolonas constituyen un grupo de antibióticos, ampliamente utilizado en infeccionesdel tracto urinario (ITU), por su excelente actividad frente a las enterobacterias y por su vía deeliminación. El objetivo de este estudio es determinar la resistencia a las fluoroquinolonas:ciprofloxacina, levofloxacina y gatifloxacina en bacilos gramnegativos aislados de ITU. Se incluyeronen el estudio todos los bacilos gramnegativos, aislados de pacientes adultos con ITU, queconcurrieron en forma consecutiva al laboratorio San Roque, desde junio de 2005 a marzo de 2006.Para determinar la resistencia, se utilizó el método de difusión en agar siguiendo normasestandarizadas del NCCLS. De las 380 cepas aisladas el 81,7% correspondió a Escherichia coli,11,6% Klebsiella pneumoniae, 3,4% Proteus mirabilis, 1% Enterobacter aerógenes, 0,8%Enterobacter cloacae, 0,5% Citrobacter koseri, 0,5% Citrobacter freundii y 0,5% Klebsiella oxytoca.El 17,6% de todos los aislamientos, fue resistente a todas las fluoroquinolonas ensayadas (58cepas de E. coli, 7 cepas de K. pneumoniae y 2 de E. cloacae). La resistencia de E. coli a las tresfluoroquinolonas fue del 18,7%, y de K. pneumoniae 15,9%. Una cepa de E. coli, sensible agatifloxacina, presentó sensibilidad intermedia a ciprofloxacina y levofloxacina. Las tresfluoroquinolonas testadas presentaron igual actividad frente a bacilos gramnegativos, aislados deITU. Esta resistencia es relativamente alta, debido a que la resistencia a un antibiótico a serutilizado en forma empírica, no debe superar el 20%

Antibiotic resistance pattern and visual outcome in experimentally-induced Staphylococcus epidermidis endophthalmitis in a rabbit model.

OBJECTIVE: To study whether the clinical outcome of Staphylococcus epidermidis-induced endophthalmitis in rabbits is related to the antibiotic resistance pattern of the infecting strain. DESIGN: Experimental animal study. PARTICIPANTS: The right eyes of 36 New Zealand white albino rabbits were inoculated with strains of S. epidermidis that displayed various patterns of antibiotic resistance. METHODS: There were 12 rabbits in each of three study groups: fully antibiotic susceptible (FS), partially antibiotic resistant (PR), and multiresistant (MR). Five days after inoculation, the eyes were enucleated and prepared for histologic studies. MAIN OUTCOME MEASURES: Comparisons among the three groups were made based on electroretinographic (ERG) findings, histologic evaluation by a masked observer, and clinical examination. RESULTS: Electroretinographic findings on all rabbits were made by an unmasked observer. At 30 hours after inoculation, the ERG was diminished to 65% of normal for group FS, compared with a flat ERG waveform for groups PR (P < 0.05) and MR (P < 0.05). The ERG waveform was flat for all three groups at 72 hours after inoculation. Histologic evaluation by use of a histologic score revealed that the degree of inflammation and destruction of the retina was less for group FS (n = 10) compared with groups PR (n = 8) and MR (n = 8). Clinical examination revealed that there was a trend of less ocular inflammation for group FS compared with groups PR and MR. CONCLUSIONS: In a rabbit model of S. epidermidis-induced endophthalmitis, antibiotic-susceptible strains caused less inflammation and destruction of the infected retina than did antibiotic-resistant strains.

[Sterilization of phacoemulsification and vitrectomy instruments. Contamination and evaluation]. / Hygiene von Phakoemulsifikations- und Vitrektomiegeräten. Kontamination und Bewertung.

BACKGROUND: Contamination of automated surgical equipment is widely disregarded as a potential source of perioperative infection. We investigated the possibility of contamination of the aspiration fluid by the vacuum control manifold (VCM). The normal, unsterile internal VCM was compared with a modified external VCM that was regularly disinfected. MATERIALS AND METHODS: We investigated 37 aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. There were 25 specimens from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 specimens from one system equipped with a modified external VCM (control group). No hygiene procedures were used with the hidden internal VCM, but the modified external VCM was regularly rinsed and filled with 70% isopropanol overnight. Specimens were collected under sterile conditions, centrifuged, cultured for bacterial growth on blood agar and MacConkey agar for 24-48 h at 37 degrees C, and analyzed microbiologically. RESULTS: Aspiration fluids of irrigation/aspiration systems used for intraocular surgery were found to be severely contaminated with bacteria originating from the VCM. In all aspiration fluid specimens from internal VCM systems, 2(+)-4+ bacterial growth was found. Stenotrophomonas maltophilia (17), Comamonas acidovorans (8), and Agrobacterium radiobacter (13) were found most frequently. All specimens from the modified external VCM system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between experimental and control groups (P = 0.0001, chi 2). CONCLUSIONS: We found that the aspiration fluid of common phaco- and vitrectomy systems was strongly contaminated by bacteria originating from the internal VCM. The technical modification of an external VCM allows easy disinfection and prevents contamination of the aspiration fluid.

Automated surgical equipment requires routine disinfection of vacuum control manifold to prevent postoperative endophthalmitis.

PURPOSE: Contamination of automated surgical equipment is a potential source of postoperative endophthalmitis. The effect of disinfecting the unsterile vacuum control manifold (VCM) on contamination of the aspiration fluid was studied. DESIGN: Comparative prospective microbiologic contamination study. SPECIMENS AND CONTROLS: The 37 aspiration fluid specimens studied or examined consisted of 25 from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 from one system equipped with a modified external VCM (control group). In addition, the tubings of two internal VCMs were investigated. METHODS: We investigated aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. After tracing the source of contamination to the internal VCM, the system was modified, creating an external VCM with the possibility for disinfection, and the study was continued. Whereas no sterilizing rinsing procedures were applied to the hidden internal VCM, the modified external VCM was regularly rinsed and filled overnight with 70% isopropanol. All samples were collected under sterile conditions, centrifuged, and cultured for bacterial growth on blood agar and MacConkey agar for 24 to 48 hours at 37 degrees C. The samples of the two internal VCMs were cultured for fungi as well. MAIN OUTCOME MEASURES: Bacterial growth was quantified, and bacteria and fungi were isolated and identified according to standard microbiologic procedures. RESULTS: In all aspiration fluid specimens from internal VCM-systems, 2+ to 4+ bacterial growth was found. Pseudomonas-related genera (Stenotrophomonas maltophilia, 17x; Comamonas acidovorans, 8x; Chryseomonas spp., 3x), Agrobacterium radiobacter (1 3x), Flavobacterium spp. (3x), and Micrococcus luteus (7x) were found most frequently. The tubing of the two VCMs contained biofilms exhibiting several of these bacteria and fungi. All specimens from the modified external VCM-system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between the experimental and control groups (chi-square: P = 0.0001). CONCLUSIONS: The technical modification described herein allows facile hygienic measures, by which contamination of aspiration fluid by the VCM can be eliminated, which otherwise can be a significant source of contamination.

[Preoperative infection prophylaxis with 1% polyvidon-iodine solution based on the example of conjunctival staphylococci]. / Präoperative Infektionsprophylaxe mit 1 %iger Polyvidon-Jod-Lösung am Beispiel von konjunktivalen Staphylokokken.

BACKGROUND: Most germs causing postoperative endophthalmitis derive from the conjunctival bacterial normal flora. Postoperative endophthalmitis is often induced by staphylococcal germs. The application of polyvidone-iodine solution to the conjunctiva is one possibility to reduce potential endophthalmitis-causing bacteria. The aim of this study was to evaluate the effectiveness of 1% polyvidone-iodine solution concerning the reduction of colonization with staphylococci in the course of intraocular surgery. This is to evaluate the effectiveness of 1% polyvidone-iodine solution concerning coagulase-negative and positive staphylococci. PATIENTS AND METHODS: Patients with intrabulbar surgery (300) had three conjunctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after antisepsis with polyvidone-iodine before opening the conjunctiva. At the end of surgery the third smear was taken. RESULTS: In 30.3% staphylococci were isolated from eyes before disinfection. Some patients (7.7%) were staphylococci-positive after disinfection; 5.3% of the patients showed staphylococcal growth at the end of surgery. To evaluate the effectiveness of polyvidone-iodine 1% solution we compared the first and the second smear (Mc Nemar). We found a statistically significant reduction (P < 0.001). At the end of surgery the conjunctival colonization with staphylococcal germs remained statistically significant reduced (P < 0.001). The mean operation time was 37 +/- 24 min. CONCLUSIONS: We concluded that a significant reduction of a staphylococcal colonization can be achieved by preoperative application of polyvidone-iodine (1%) (P < 0.001). Even at the end of surgery the effect of 1% polyvidone-iodine solution held.

[Bacterial keratitis. Microbiological analysis as a principle for therapeutic recommendations]. / Bakterielle Keratitis. Mikrobiologische Analyse als Grundlage für Therapieempfehlungen.

PURPOSE: The study presented differentiates between the aetiological agents of bacterial keratitis in patients with and without a history of contact lens wear. Based on these results, recommendations are given for optimal antibiotic primary therapy. PATIENTS AND METHODS: Swabs and corneal scrapings were taken from 218 patients referred to the University Eye Hospital in Munich with a diagnosis of bacterial keratitis from 1989 to 1997. Ninety-two of these patients had a history of contact lens wear; 126 had none. The germs were isolated and identified by staining and microscopy. Observing polymicrobial growth in 51 patients, a total of 275 germs was isolated. RESULTS: The most frequent pathogens were Staphylococcus epidermidis (44%), S. aureus (18%), Streptococcus spp. (10%), Propionibacterium acnes (7%) and Pseudomonas aeruginosa (6%). Gram-negative germs were nearly exclusively isolated from contact lens wearers, gram-positive germs were predominant in non-contact lens wearers. CONCLUSION: Keratitis in patients with a history of contact lens wear is often caused by aggressive gram-negative germs. Those cases should immediately be treated with quinolones and erythromycin. In keratitis caused by gram-positive pathogens, a combination with aminoglycosides and erythromycin is sufficient.

[Secondary glaucoma in Paraguay. Etiology and incidence]. / Das Sekundärglaukom in Paraguay. Ursachen und ihre Häufigkeitsverteilung.

Glaucoma is the third-most-frequent cause of blindness in the world, with a total of 5.2 million blind people as a result of this disease; 80% live in developing countries. In Paraguay, after cataract it is the second-most-frequent-cause. Early detection of the risk factors and groups can help to avoid progress of this disease. Trauma, cataract and infectious uveitis represent special risks for developing secondary glaucoma, which is a more frequent cause of blindness in third-world countries than in industrialized nations. Until now there has been little data regarding the causes, disease course, and options for therapy. Therefore, secondary glaucoma was examined in Paraguay to obtain information on the situation in Latin America. The aim of the study was to explore the causes of secondary glaucoma for programs concerning prevention and therapy. From November 1996 to February 1997 patients with secondary glaucoma were examined at the University Hospital of Asunción, Paraguay. After the clinical examination the secondary glaucomas were classified. Patients with primary glaucoma were included in the same period of time as well in order to get the rate of secondary glaucoma. Altogether 293 patients were examined: 61 with secondary and 232 with primary glaucoma. The causes of secondary glaucoma in 73 eyes were: 20 (27%) with pseudoexfoliation glaucoma, 19 (26%) with post-traumatic glaucoma, 16 (22%) with neovascular glaucoma, 4 (5%) with lens-related glaucoma, 3 (4%) with glaucoma associated with ocular surgery, 2 (3%) with pigmentary and 2 (3%) with corticoid-induced glaucoma. A ratio of 4:1 primary glaucomas to secondary glaucomas was found. The development of special measures for prevention and early therapy is only possible if the causes of this severe disease are explored. The results of this study represent basic information and could help to introduce of prevention programs.

[Post-traumatic endophthalmitis after penetrating eye injuries. Risk factors, microbiological diagnosis and functional outcome]. / Posttraumatische Endophthalmitis nach penetrierenden Augenverletzungen. Risikofaktoren, mikrobiologische Diagnostik und funktionelle Ergebnisse.

BACKGROUND: Endophthalmitis associated with penetrating injury represents a distinct kind of intraocular infection. The preceding trauma, infective agents and inflammatory changes determine the functional outcome. MATERIALS AND METHODS: In a retrospective study, 18 patients with endophthalmitis were investigated and compared to a control group of 54 patients with penetrating ocular trauma. A number of clinical variables were evaluated for association with an increased risk of endophthalmitis. RESULTS: Risk factors found to be significant were: (1) a purely corneal wound, (2) surgical primary repair more than 24 h after injury and (3) initiation of intravenous antibiotic therapy later than 24 h after trauma. A two-fold increased relative risk was related to the presence of an intraocular foreign body, lens injury and a wound length less than 5 mm. Direct inoculation of surgical specimens and immediate microbiological processing succeeded in the presumptive identification of infective agents with preliminary therapeutic recommendations in 72% of the patients. CONCLUSIONS: In "risk eyes" particular attention should be paid to prophylaxis and signs of infection.

[Eye involvement in Chagas disease (American trypanosomiasis). 1996/1997 studies in Paraguay]. / Augenbeteiligung bei Chagas-Krankheit (Amerikanische Trypanosomiasis). Untersuchungen in Paraguay 1996/1997.

BACKGROUND: Last year's pilot study, which examined for the first time a representative group of patients with Chagas disease, showed that in this parasitosis changes in the ocular fundus can be expected in the form of defects of the retinal pigment epithelium. Examination of more patients in this study should give further information about the character and extent of the alterations found. MATERIALS AND METHODS: After serological confirmation of the disease, we performed an ophthalmological examination of the anterior and posterior segments. RESULTS: In 21 out of 23 patients the fundus was unobtrusive; 1 patient showed fibrae medullares and 1 patient clear pigment dispersion on the posterior pole. Together with the pilot study, a total of 102 chagasic patients were examined. In 8 patients (7.8%) defects of the retinal pigment epithelium were found, which did not cause any significant loss of vision. CONCLUSIONS: We presume that the described defects are a matter of rare and harmless postinflammatory or immunological changes in the American type of trypanosomiasis.

[Ophthalmia neonatorum caused by Chlamydia trachomatis. Rapid diagnosis and therapy]. / Ophthalmia neonatorum durch Chlamydia trachomatis. Schnelldiagnostik und Therapie.

BACKGROUND: In up to 73% of ophthalmia neonatorum, Chlamydia trachomatis is the causative agents. Untreated sequelae to the eyes and organs may be the result. The aim of this study was to determine the bacterial spectrum of ophthalmia neonatorum with special regard to chlamydia and their diagnostic tests. MATERIALS AND METHODS: We compared the results of 15 newborn with ophthalmia neonatorum. For the diagnosis we used a rapid diagnostic test, Immunofluorescent Antibody Staining and Culture on McCoy cells. Bacteria that were cultured on culture media were also identified. RESULTS: In 66% the newborn showed a positive rapid diagnostic test result that was confirmed by Immunofluorescent Antibody Staining. In 5 patients all tests were negative. CONCLUSIONS: In this study C. trachomatis was the most frequent pathogen. In the culture media we isolated mostly gram-positive cocci but not Neisseria gonorrhoeae. We point out the value of an exact rapid diagnosis and specific treatment to avoid sequelae to the eye and organs.

[Intraocular involvement of Chagas disease (American trypanosomiasis). Studies in Paraguay/South America]. / Beteiligung der Chagas-Krankheit (Amerikanische Trypanosomiasis) am inneren Auge. Untersuchungen in Paraguay/Südamerika.

BACKGROUND: In Central and South America, Chagas' disease is of great epidemiologic importance. The epidemiologic agent is represented by Trypanosoma cruzi, a monocellular parasite, instrumental in human infection is the presence of vectors, which are various species of hematophagous bugs. The eye is one of the most important entrance sites of the parasite, and relatively little information about the relationship between Chagas' disease and eye complications is available. PATIENTS AND METHODS: We examined 79 chagasic patients in order to detect changes in the retina. As a control group, we examined 48 patients with negative serology within the same age range and from the same regions. For every patient we completed a routine ophthalmologic examination, with inspection of the retina using direct and indirect ophthalmoscopy. RESULTS: In most of the chagasic patients, the ocular fundus was unobtrusive; in only 6 out of 79 cases (7.6%) we did observe small parafoveolar retinal pigment epithelium defects and in 1 case (1.3%) distinct pigment epithelium atrophy of the posterior pole. No comparable findings were observed in the control group. CONCLUSION: Compared with the examination results of the control group, in the patients with intermediate and chronic Chagas' disease we observed an accumulation of retinal pigment epithelium defects, which, however, did not cause a significant loss of vision.