Prevention of cellulitis after open lacrimal surgery: a prospective study of three methods.

OBJECTIVE

Soft-tissue cellulitis after open lacrimal surgery, almost exclusively caused by infection, is associated with a reduced surgical success rate, inconvenience for the patient, and may predispose to secondary hemorrhage. Although postoperative oral antibiotics have been shown to significantly reduce the infection rate, this investigation was designed to compare this regimen with two other methods for the prevention of postoperative infection.

DESIGN

A prospective nonrandomized comparative trial of three methods for prevention of postoperative infection.

PARTICIPANTS

Patients, recruited over a 16-month period from the Lacrimal Clinic at Moorfields Eye Hospital, who required primary open dacryocystorhinostomy.

METHOD

Two hundred and sixty-five patients were assigned, on the basis of hospital number, to one of three groups: to receive either an intravenous broad-spectrum antibiotic immediately after induction of anesthesia (group 1), intraoperative lavage of the rhinostomy site just after suture of the anterior mucosal flaps (group 2), or a postoperative course of oral antibiotics (group 3).

OUTCOME MEASURES

Cellulitis was considered to be present when there was marked tenderness along a swollen and erythematous incision line, evidence of frank pus from the suture line, or late postoperative hemorrhage occurred. Patients were reviewed within a week of surgery.

RESULTS

Signs of infective cellulitis occurred in 1 of 127 (0.8%) cases in group 1, 7 of 41 (18%) cases in group 2, and 2 of 127 (1.5%) cases in group 3. Whereas the infection rate in group 2 was significantly greater than that in group 1 (P << 0.001) or group 3 (P<0.001), no significant difference was found between that in groups 1 and 3 (0.75>P>0.5; chi-square test with Yates' correction).

CONCLUSION

Compared with intraoperative saline lavage, intraoperative or postoperative broad-spectrum antibiotics have comparable efficacy in the prevention of postoperative soft-tissue cellulitis after open lacrimal surgery. Intraoperative administration of antibiotics has the advantages of compliance and economics.