Clear corneal wound infection after phacoemulsification

Objective: To evaluate clear corneal wound infections after phacoemulsifica tion. Materials and Methods: The medical records of 7 patients with clear corneal wound infections after phacoemulsification were reviewed retrospectively. Data that were reviewed included patient age, sex, onset of symptoms and si gns after surgery, possible risk factors for infection, concomitant ocular disease, use of perioperative prophylactic antibiotics and steroids, cultur e and antibiotic sensitivity results, treatment regimen, and outcome. Results: The median onset of signs and symptoms after surgery was 10 days ( range, 4-60 days). Corneal cultures yielded methicillin-resistant Staphyloc occus aureus in 2 cases, Streptococcus pneumoniae in 1 case, and Staphyloco ccus epidermidis in 1 case. Cultures yielded no microorganisms for 1 patien t. Corneal cultures were not obtained in 2 patients. In 3 of the 4 culture- positive cases, the isolated microorganisms were resistant to the periopera tive prophylactic antibiotics (fluoroquinolones and tobramycin) that were u sed. No possible risk factors were noted except use of topical steroids 4 t imes a day without antibiotic coverage for iritis before referral in one of our patients. Six of these 7 wound infections healed with topical antibiot ic therapy. One of the patients required lamellar keratectomy and conjuncti val flap for complete healing. in 4 of the 7 cases, best-corrected visual a cuity at the last follow-up visit was better than 20/40. Conclusions: Clear corneal wound infection after phacoemulsification is a s erious complication of cataract surgery. Infections are caused by gram-posi tive organisms sensitive to bacitracin and the combination of trimethoprim- sulfamethoxazole but often resistant to aminoglycosides and/or fluoroquinol ones.