Prevention of cellulitis after open lacrimal surgery - A prospective studyof three methods

Objective: Soft-tissue cellulitis after open lacrimal surgery, almost exclu sively caused by infection, is associated with a reduced surgical success r ate, inconvenience for the patient, and may predispose to secondary hemorrh age, Although postoperative oral antibiotics have been shown to significant ly reduce the infection rate, this investigation was designed to compare th is regimen with two other methods for the prevention of postoperative infec tion. Design: A prospective nonrandomized comparative trial of three methods for prevention of postoperative infection. Participants: Patients, recruited over a 16-month period from the Lacrimal Clinic at Moorfields Eye Hospital, who required primary open dacryocystorhi nostomy. Method: Two hundred and sixty-five patients were assigned, on the basis of hospital number, to one of three groups: to receive either an intravenous b road-spectrum antibiotic immediately after induction of anesthesia (group 1 ), intraoperative lavage of the rhinostomy site just after suture of the an terior mucosal flaps (group 2), or a postoperative course of oral antibioti cs (group 3). Outcome Measures: Cellulitis was considered to be present when there was ma rked tenderness along a swollen and erythematous incision line, evidence of frank pus from the suture line, or late postoperative hemorrhage occurred. Patients were reviewed within a week of surgery. Results: Signs of infective cellulitis occurred in 1 of 127 (0.8%) cases in group 1, 7 of 41 (18%) cases in group 2, and 2 of 127 (1.5%) cases in grou p 3. Whereas the infection rate in group 2 was significantly greater than t hat in group 1 (P << 0.001) or group 3 (P < 0.001), no significant differen ce was found between that in groups 1 and 3 (0.75 > P > 0.5; chi-square tes t with Yates' correction). Conclusion: Compared with intraoperative saline lavage, intraoperative or p ostoperative broad-spectrum antibiotics have comparable efficacy in the pre vention of postoperative soft-tissue cellulitis after open lacrimal surgery . Intraoperative administration of antibiotics has the advantages of compli ance and economics. (C) 2000 by the American Academy of Ophthalmology.