BENEFIT OF ANTISEPSIS IN THE PROPHYLACTIC CHEMO-ANTIBIOTIC TREATMENT OF POSTOPERATIVE ENDOPHTHALMITIS

A protocol associating chemoprophylaxis and two-agent flash antibiopro phylaxis was performed for more than two years in order to prevent pos toperative endophthalmitis in elective open-globe surgery. The aim of this study is to appreciate' whether antibiotic therapy is really usef ul as a complement to chemoprophylaxis. Three successive conjunctival scrapings were performed in the operating room : two before surgery (o ne before and one after conjunctival disinfection by povidone iodine), and the third one at the end of the operation. The total number of po sitive scrapings significantly decreased after disinfection but, some changes appeared on the final scrapings positive and negative. The ris ks of a positive scraping after the disinfection are greater if the sc raping was initially positive. The persistence of a positive scraping after disinfection is noted in about 20% of cases. Therefore, there is a risk for microorganisms to penetrate into the eye, still present on the conjunctiva after povidone iodine. This risk is an argument to ca rry on the flash antibiotic therapy before surgery, in order to obtain a high intravitreal concentration of antibiotics at the precise time when the bacteria may penetrate into the eye, and to stop their multip lication.