Abstract
Purpose :
Our previous study of 26 patients with endophthalmitis after strabismus surgery doi:10.1111/aos.14446 showed that most cases occur in children aged 6 or less, exclusively after medial rectus recession. John Sloper from Moorfields Eye Hospital suggested reflux from the lacrimal puncta as a possible cause. Our Povidone-Iodine (PI) Antisepsis for Strabismus Surgery RCT did not demonstrate a difference between rinsing with 1.25% vs. 5% PI but, surprisingly, many reattached medial rectus muscles (RMR) carried bacteria.
Methods :
Conjunctiva was irrigated with 1.25% or 5% PI prior surgery. Smears were obtained for aerobic and anaerobic bacteria with moistened dissolving Ca-alginate swabs from nose and conjunctiva before PI irrigation, from conjunctiva 5 minutes after PI irrigation, from RMR, and from conjunctiva after its closure (CC). Specimens were inoculated and cultivated onto blood/chocolate agars and in thioglycolate broth for 3-5 days.
Results :
70 Children were included. Case #20-70 had nose cultures. Case #53-70 had lacrimal sack compression added to PI irrigation. Bacteria were found on RMR in 7, on CC in another 2, of 19 cases without nose cultures. Bacteria were found on RMR in 9, on CC in another 5, of 33 cases with nose cultures; in 9 of these 9+5=14 cases, the bacteriae in the nose and on RMR or CC were the same. Bacteria were found on RMR in 3, on CC in 0, of 18 cases with lacrimal sack compression added tot PI irrigation; in 1 of these 3 cases, the bacteria in the nose and on RMR were the same. In some cases where nose and RMR bacteria were the same, the conjunctiva had contained other bacteria before surgery.
Conclusions :
In 44.2% of the first 52 cases, bacteriae were found on RMR or CC. Of the 33 cases of these that had nose cultures, 64.3% of 14 cases with bacteria on RMR or CC carried the same bacteria in the nose. Of the 18 cases with lacrimal sack compression added to PI irrigation only 16.7% had bacteriae on RMR and none on CC.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.