Barequet I S, Jabbur N S, Barron Y, Osterhout G J, O'Brien T P
Refractive Surgery Service, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21093, USA.
J Refract Surg. 2001 Jan-Feb;17(1):55-62. doi: 10.3928/1081-597X-20010101-07.
Therapeutic soft contact lenses are used commonly as an adjunctive treatment after photorefractive keratectomy (PRK) to decrease postoperative pain caused by the movement of lids over the corneal epithelial defect and to facilitate epithelial healing. We assessed the microbiological profile of the conjunctiva of patients undergoing PRK for myopia, before and after the concurrent use of a therapeutic soft contact lens, and compared the effect on ocular bacterial colonization of prophylactic administration of topical tobramycin 0.3% versus ofloxacin 0.3%.
Forty-three consecutive eyes from 37 patients underwent PRK for myopia or myopic astigmatism. Eyes were assigned randomly to prophylactic antibacterial treatment with either topical ofloxacin 0.3% or tobramycin 0.3%, applied prior to surgery and three times daily after surgery until therapeutic soft contact lens removal. Material from the conjunctival sac was obtained for bacteriologic cultures prior to surgery. Clinical evaluation of all eyes was conducted prospectively. Three days after PRK, the therapeutic soft contact lenses were removed and cultured. Cultures from the conjunctival sac were then repeated.
No statistically significant differences were observed in culture positivity between the two groups of eyes, in spite of some positive preoperative and postoperative cultures. Only one out of 43 eyes (assigned to the ofloxacin group) developed a peripheral corneal infiltrate. The corneal infiltrate healed completely without sequelae using antibiotic and corticosteroid therapy.
The use of therapeutic soft contact lenses after PRK with either topical tobramycin 0.3% or ofloxacin 0.3% were well tolerated. However, perioperative positive conjunctival cultures were relatively frequent and prophylactic antibiotics should be used in the setting of an epithelial defect and therapeutic soft contact lens following PRK.
治疗性软性接触镜常用于准分子激光原位角膜磨镶术（PRK）后作为辅助治疗，以减轻因眼睑在角膜上皮缺损处移动引起的术后疼痛，并促进上皮愈合。我们评估了近视患者在同时使用治疗性软性接触镜前后PRK结膜的微生物学特征，并比较了预防性局部应用0.3%妥布霉素与0.3%氧氟沙星对眼部细菌定植的影响。
37例患者的43只眼睛连续接受PRK治疗近视或近视散光。术前随机分配使用0.3%氧氟沙星或0.3%妥布霉素进行预防性抗菌治疗，术后每日三次，直至取出治疗性软性接触镜。术前从结膜囊取材进行细菌培养。对所有眼睛进行前瞻性临床评估。PRK术后三天，取出治疗性软性接触镜并进行培养。然后再次对结膜囊进行培养。
尽管术前和术后培养有一些阳性结果，但两组眼睛的培养阳性率没有统计学上的显著差异。43只眼中只有1只（分配到氧氟沙星组）出现周边角膜浸润。使用抗生素和皮质类固醇治疗后角膜浸润完全愈合，无后遗症。
PRK术后使用0.3%妥布霉素或0.3%氧氟沙星的治疗性软性接触镜耐受性良好。然而，围手术期结膜培养阳性相对常见，在PRK术后上皮缺损和使用治疗性软性接触镜的情况下应使用预防性抗生素。
