Eustis H Sprague, Rhodes Annette
Department of Ophthalmology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
J Pediatr Ophthalmol Strabismus. 2012 Jul-Aug;49(4):206-9. doi: 10.3928/01913913-20110920-01.
To document the contamination rate of sutures used in strabismus surgery and evaluate the reduction of contamination using antibiotic-coated and antiseptic/antibiotic-coated sutures.
This was a prospective randomized analysis of suture contamination and potential prophylaxis measures after strabismus surgery. Muscle sutures (6-0 polyglactin) used in 302 consecutive cases of strabismus from October 2008 to May 2009 were collected and randomly assigned to three groups: (1) a control without pretreatment sutures (61); (2) antibiotic/steroid-coated sutures (200); and (3) antiseptic-soaked and antibiotic/steroid-coated sutures (141). The sutures were used under sterile conditions and then cut into pieces and transferred to blood agar plates, which were incubated for 48 hours and then checked for growth.
Group 1 had bacterial growth in 17 of 61 (28%) sutures; group 2 had growth in 44 of 200 (22%) sutures; and group 3 had growth in 12 of 141 (9%) sutures. The reduction in bacterial growth using the antibiotic/antiseptic coating was significant (P = .006). One patient developed coagulase-negative Staphylococcus epidermidis endophthalmitis 1 week after surgery, which was promptly diagnosed and successfully treated. No complications from the antibiotic-coated or antiseptic-soaked sutures were noted.
Although endophthalmitis after strabismus surgery is rare, estimated at 1 in 35,000 to 1 in 185,000, visual outcome is uniformly poor. The authors hypothesize that strabismus sutures can be contaminated via contact with the eyelashes and skin, providing a possible conduit for endophthalmitis. Bacterial contamination of strabismus sutures is high (28%) and can be reduced significantly if sutures are soaked in antiseptic before use.
记录斜视手术中使用的缝线污染率，并评估使用抗生素涂层缝线和抗菌/抗生素涂层缝线对污染的降低情况。
这是一项关于斜视手术后缝线污染及潜在预防措施的前瞻性随机分析。收集了2008年10月至2009年5月连续302例斜视手术中使用的肌肉缝线（6-0聚乙醇酸缝线），并随机分为三组：（1）未预处理缝线对照组（61例）；（2）抗生素/类固醇涂层缝线组（200例）；（3）抗菌浸泡及抗生素/类固醇涂层缝线组（141例）。缝线在无菌条件下使用，然后切成小块转移至血琼脂平板，孵育48小时后检查有无生长。
第1组61根缝线中有17根（28%）有细菌生长；第2组200根缝线中有44根（22%）有生长；第3组141根缝线中有12根（9%）有生长。使用抗生素/抗菌涂层后细菌生长的降低具有显著性（P = 0.006）。1例患者术后1周发生凝固酶阴性表皮葡萄球菌性眼内炎，及时诊断并成功治疗。未观察到抗生素涂层或抗菌浸泡缝线引起的并发症。
虽然斜视手术后眼内炎罕见，估计发生率为35000分之一至185000分之一，但视力预后均较差。作者推测斜视缝线可能通过与睫毛和皮肤接触而被污染，这为眼内炎提供了一条可能的途径。斜视缝线的细菌污染率较高（28%），如果缝线在使用前用抗菌剂浸泡，污染率可显著降低。
