Hayashi Yuko, Miyamoto Takeshi, Fujita Shuko, Tomoyose Katsuo, Ishikawa Nobuyuki, Kokado Masahide, Sumioka Takayoshi, Okada Yuka, Saika Shizuya
Department of Ophthalmology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
Department of Ophthalmology, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Itogun, Wakayama, 649-7113, Japan.
BMC Ophthalmol. 2017 Feb 20;17(1):15. doi: 10.1186/s12886-017-0410-x.
Contamination of the conjunctiva in association with nasolacrimal duct obstruction is by all accounts a risk factor for infectious endophthalmitis post-cataract surgery.
All patients who underwent cataract day surgery routinely received nasolacrimal duct syringing with normal saline at the Wakayama Medical University Hospital, Japan, from 2011 to 2013. The microorganisms isolated from conjunctival swab samples of patients with occluded nasolacrimal ducts and their susceptibility to antibiotics, as well as the operation outcomes in all the patients were retrospectively investigated.
Nasolacrimal duct obstruction was observed in 125 eyes of 90 patients (3.3%; 42 eyes of 30 male individuals, and 83 eyes of 60 female individuals) from a total of 3754 eyes of 2384 patients by using irrigation samples of nasolacrimal ducts. The mean age of the subjects with duct obstruction was 79 ± 8.5 years.. In bacterial cultures of swabs from these 125 individuals, microbial growth was detected in 56 samples (i.e. 44.8%). Coagulase-negative Staphylococcus was detected in 28 eyes, and Corynebacterium species was detected in 17 eyes. Staphylococcus aureus, excluding methicillin-resistant S. aureus was detected in seven eyes with nasolacrimal duct obstruction. Methicillin-resistant S. aureus was isolated in two eyes with nasolacrimal duct obstruction. Each case was treated with topical antibiotics based on the results of antibiotic sensitivity tests. After culturing of cotton swab samples from the conjunctiva, and using direct micrography of bacteria every 2 or 3 days after starting treatment, and once the results were negative (consecutively tested three times), the patients received cataract surgery. In the current case series, bacteria were not detected in conjunctival swabs obtained consecutively three times for 3 weeks after starting topical antibiotics in 118 eyes from 125 eyes (94.4%), and later in the remaining patients. No patient required dacryocystorhinostomy to eliminate bacterial contamination in the conjunctiva following topical antibiotic therapy. No patient developed infectious endophthalmitis at least 1-year post-cataract surgery.
All the patients receiving cataract day surgery underwent the operation after the elimination of conjunctival microorganism contamination in association with nasolacrimal duct obstruction by using appropriate topical antibiotics.
结膜污染合并鼻泪管阻塞被公认为是白内障手术后感染性眼内炎的一个危险因素。
2011年至2013年期间，在日本和歌山医科大学医院，所有接受白内障日间手术的患者均常规接受用生理盐水冲洗鼻泪管。对鼻泪管阻塞患者结膜拭子样本中分离出的微生物及其对抗生素的敏感性，以及所有患者的手术结果进行了回顾性研究。
在2384例患者的3754只眼中，通过鼻泪管冲洗样本发现90例患者的125只眼存在鼻泪管阻塞（3.3%；30例男性患者的42只眼，60例女性患者的83只眼）。鼻泪管阻塞患者的平均年龄为79±8.5岁。在这125例患者的拭子细菌培养中，56份样本（即44.8%）检测到微生物生长。28只眼中检测到凝固酶阴性葡萄球菌，17只眼中检测到棒状杆菌属。在7例鼻泪管阻塞眼中检测到不包括耐甲氧西林金黄色葡萄球菌的金黄色葡萄球菌。在2例鼻泪管阻塞眼中分离出耐甲氧西林金黄色葡萄球菌。根据抗生素敏感性试验结果，对每例患者进行局部抗生素治疗。在结膜棉拭子样本培养后，治疗开始后每2或3天对细菌进行直接显微摄影，一旦结果为阴性（连续检测三次），患者即接受白内障手术。在本病例系列中，125只眼中有118只眼（94.4%）在开始局部抗生素治疗后3周连续三次获得的结膜拭子中未检测到细菌，其余患者随后也未检测到。局部抗生素治疗后，没有患者需要行泪囊鼻腔吻合术来消除结膜中的细菌污染。至少在白内障手术后1年，没有患者发生感染性眼内炎。
所有接受白内障日间手术的患者在使用适当的局部抗生素消除与鼻泪管阻塞相关的结膜微生物污染后才进行手术。
