INVESTIGATION OF PERIOPERATIVE CONJUNCTIV AL FLORA

Background The conjunctival flora is of great interest for each case o f intraocular operation preventing postoperative infections. Despite o f negative cultures before the operation we investigated in a prospect ive randomized study perioperatively the bacterial situation of the co njunctiva In 105 patients. Material and methods We took conjunctival s wabs for microbiological examination from patient's eye operated on ca taract or glaucoma, on the day of admission to the eye clinic and in t he morning of the operating day. In addition, specimens were taken by nurses with Transwab(R) MW-172 P before the local anaesthesia, disinfe ction of the conjunctiva and lids and application of eye drops, after these procedures by a research worker, at the end of the operation by the surgeon and two to three days after the operation by nurses with T ranswab(R) MW-172 P again. In 53 patients we collected lacrimal fluid to measure the lysozyme concentration. Results Out of 686 conjunctival swabs we have found 126 (18,4%) positive cultures. Staphylococcus epi dermidis had the highest incidence (109=86,5%) followed by Staphylococ cus aureus (7 = 5,5%). Only in 28 eyes all conjunctival sw abs, taken at different times, were negative. There was an increase of positive c ultures from routine swabs on the day of admission from 13 (12,4%), to 33 (31,7%) in the swabs taken on the day of the operation in the morn ing. On the other side the positive cultures decreased then continuous ly before and after the preparation of the operation, at the end of th e operation and during two to three days postoperatively. There was'nt any statistical correlation between the concentration of the lacrimal lysozym and the rate of positive cultures. Conclusion The praeoperati ve bacteriological diagnostic of the conjunctiva is important mainly f or the prevention of postoperative endophthalmitis despite the transie nce and fluctuation of the conjunctival flora but also in case of endo phthalmitis for rapid specific antibiotical therapy.