Zur chirurgischen Prophylaxe der postoperativen Endophthalmitis nach Phakoemulsifikation. Eine kurze Übersicht (und Wertung)

Zusammenfassung

Zur Vermeidung der postoperativen Endophthalmitis werden verschiedene Maßnahmen empfohlen. Meist sind diese medikamentöser Natur, z. B. PVP-Jod, topische Antibiotika prä-, intra- sowie postoperativ. Aufgrund der aktuellen ESCRS-Studie zur intrakameralen Antibiotikumgabe wird derzeit fast ausschließlich medikamentös diskutiert. Daher wird in der vorliegenden Übersichtsarbeit auf die Bedeutung der chirurgischen Priorität hingewiesen, ohne deshalb die medikamentöse zu vernachlässigen. Die Tunnelkonstruktion muss auch auf Druck von außen wasserdicht sein, um mit Sicherheit eine postoperative Hypotonie zu vermeiden. Im Zweifelsfall sollte eine Naht durchgeführt werden.

Abstract

To avoid a postoperative endophthalmitis several measures have been proposed. These are predominantly drug-related, e. g. PVP-iodine, topical antibiotics pre-, intra- and postoperatively. Due to the actual ESCRS study for intracameral antibiotics, the current discussion focusses almost exclusively on drug-related causes. Therefore, in this paper the surgical priority is pointed out without neglecting the drug-related causes. The construction of the tunnel must be water-tight even under pressure from outside to avoid a postoperative hypotony. In cases of doubt the tunnel should be sutured.

Infektiologie - Endophthalmitis - Prophylaxe - clear-cornea-incision - corneal-sclera-incision - Tunneltechnik

infectious diseases - endophthalmitis - prophylaxis - clear-corneal incision - corneal-sclera incision - tunnel construction

Literatur

• 1 Apt L, Isenberg S J, Yoshimori R. et al . Outpatient topical use of povidone-iodine in preparing the eye for surgery.  Ophthalmology. 1989;  96 289-292
• 2 Baillif S, Ecochard R, Casoli E. et al . Adherence and kinetics of biofilm formation of Staphylococcus epidermidis to different types of intraocular lenses under dynamic flow conditions.  J Cataract Refract Surg. 2008;  34 153-158
• 3 Barry P, Behrens-Baumann W, Pleyer U. et al . ESCRS Guidelines on prevention, investigation and management of post-operative endophthalmitis. Version 2.  European Society for Cataract&Refractive Surgery. 2007;  1-36
• 4 Behrens-Baumann W, Dobrinski B, Zimmermann O. Bakterienflora der Lider nach präoperativer Desinfektion.  Klin Monatsbl Augenheilkd. 1988;  193 40-43
• 5 Behrens-Baumann W, Augustin A J, Dick B. et al . Leitlinie zur Prophylaxe und Therapie von Endophthalmitiden. Stand Juli 2005.  Hyg Med. 2005;  30 (Heft 10) 342-362. Erratum in Hyg Med 2005, 30 (Heft 11): 409
• 6 Berdahl J P, De Stafeno J J, Kim T. Corneal wound architecture and integrity after phacoemulsification evaluation of coaxial, microincision coaxial, and microincision bimanual techniques.  J Cataract Refract Surg. 2007;  33 510-515
• 7 Caillon J, Juvin M E, Pirault J L. et al . Bactericidal effect of daptomycin (LY 146 032) compared with vancomycine and teicoplanin against gram-positive bacteria.  Pathol Biol. 1989;  37 540-548
• 8 Chang D F, Braga-Mele R, Mamalis N. et al . for the ASCRS Cataract Clinical Committee: Prophylaxis of postoperative endophthalmitis after cataract surgery. Results of the 2007 ASCRS member survey.  J Cataract Refract Surg. 2007;  33 1801-1805
• 9 Chee S P, Med M, Bacsal K. Endophthalmitis after microincision cataract surgery.  J Cataract Refract Surg. 2005;  31 1834-1835
• 10 Coleman D J, Trokel S. Direct-recorded intraocular pressure variations in a human subject.  Arch Ophthalmol. 1969;  82 637-640
• 11 Cooper B A, Holekamp N M, Bohigian G. et al . Case-control study of endophthalmitis after cataract surgery comparing scleral tunnel and clear corneal wounds.  Am J Ophthalmol. 2003;  136 300-305
• 12 Dickey J B, Thompson K D, Jay W M. Anterior chamber aspirate cultures after uncomplicated cataract surgery.  Am J Ophthalmol. 1991;  112 278-282
• 13 Doane M G. Interactions of eyelids and tears in corneal wetting and the dynamics of the normal human eyeblink.  Am J Ophthalmol. 1980;  89 507-516
• 14 Egger S F, Huber-Spitzy V, Skorpik C. et al . Different techniques of extracapsular cataract extraction: bacterial contamination during surgery. Prospective study on 230 consecutive patients.  Graefes Arch Clin Exp Ophthalmol. 1994;  232 308-311
• 15 ESCRS Endophthalmitis Study Group . Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors.  J Cataract Refract Surg. 2007;  33 978-988
• 16 Gajjar D, Praveen M R, Vasavada A R. et al . Ingress of bacterial inoculum into the anterior chamber after bimanual and microcoaxial phacoemulsification in rabbits.  J Cataract Refract Surg. 2007;  33 2129-2134
• 17 Garcia-Arumi J, Fonollosa A, Sararols L. et al . Topical anesthesia: Possible risk factor for endophthalmitis after cataract extraction.  J Cataract Refract Surg. 2007;  33 989-992
• 18 Gray T B, Keenan U I, Clemett R S. et al . Fusidic acid prophylaxis before cataract surgery: patient self-administration.  Aust New Zealand J Ophthalmol. 1993;  21 99-103
• 19 Gritz D C, Cevallos A V, Smolin G. et al . Antibiotic supplementation of intraocular irrigating solutions. An in vitro model of antibacterial action.  Ophthalmology. 1996;  103 1208-1209
• 20 Henry J C, Rozas D. Bacterial growth from anterior chamber fluid aspirates using different irrigating solutions in phacoemulsification.  Invest Ophthalmol Vis Sci. 1993;  34 (Suppl) 884
• 21 Isenberg S J, Apt L, Yoshimori R. et al . Chemical preparation of the eye in ophthalmic surgery. IV. Comparison of povidone-iodine on the conjunctiva with a prophylactic antibiotic.  Arch Ophthalmol. 1985;  103 1340-1342
• 22 Isenberg S J, Apt L, Yoshimori R. et al . Efficacy of topical povidone-iodine during the first week after ophthalmic surgery.  Am J Ophthalmol. 1997;  124 31-35
• 23 Jensen M K, Fiscella R G, Crandall A S. et al . A retrospective study of endophthalmitis rates comparing quinolone antibiotics.  Am J Ophthalmol. 2005;  139 141-148
• 24 Keverline M R, Kowalski R P, Dhaliwal D K. In vitro comparison of Ciprofloxacin, Ofloxacin, and Povidone-Iodine for surgical prophylaxis.  J Cataract Refract Surg. 2002;  28 915-916
• 25 Kowalski R P, Karenchak L M, Warren B B. et al . Time-kill profiles of Enterococcus to antibiotics used for intravitreal therapy.  Ophthalmic Surg Lasers. 1998;  29 295-299
• 26 Leong J K, Shah R, McCluskey P J. et al . Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery.  J Cataract Refract Surg. 2002;  28 826-833
• 27 Liesegang T J. Intracameral antibiotics: Questions for the United States based on prospective studies.  J Cataract Refract Surg. 2008;  34 505-509
• 28 Maeck C R, Eckardt C, Höller C. Comparison of bacterial growth on the conjunctiva after treatment with gentamicin or povidone-iodine.  Fortschr Ophthalmol. 1991;  88 848-851
• 29 Mah F S, Romanowski E G, Kowalski R P. et al . Zymar (Gatifloxacin 0,3 %) shows excellent gram-negative activity against serratia marcescens and pseudomonas aeruginosa in a New Zealand white rabbit keratitis model.  Cornea. 2007;  26 585-588
• 30 Mamalis N. Intracameral medication: Is it worth the risk?.  J Cataract Refract Surg. 2008;  34 339-340
• 31 Masket S. Is there a relationship between clear corneal cataract incisions and endophhtalmitis?.  J Cataract Refract Surg. 2005;  31 643-645
• 32 Masket S, Belani S. Proper wound construction to prevent short-term ocular hypotony after clear corneal incision cataract surgery.  J Cataract Refract Surg. 2007;  33 383-386
• 33 Maxwell D P, Diamond J G, Jay D R. Surgical wound defects associated with endophthalmitis.  Ophthalmic Surg. 1994;  25 157-161
• 34 Mc Donnell P J, Taban Jr M, Sarayba M A. et al . Dynamic morphology of clear corneal cataract incisions.  Ophthalmology. 2003;  110 2342-2348
• 35 Miller D. Pressure of the lid on the eye.  Arch Ophthalmol. 1967;  78 328-330
• 36 Miño de Kaspar H, Grasbon T, Kampik A. Automated surgical equipment requires routine disinfection of vacuum control manifold to prevent postoperative endophthalmiits.  Ophthalmology. 2000;  107 685-690
• 37 Miño de Kaspar H, Chang R T, Shriver E M. et al . Three-day application of topical ofloxacin reduces the contamination rate of microsurgical knives in cataract surgery.  Ophthalmology. 2004;  111 1352-1355
• 38 Mistlberger A, Ruckhofer J, Raithel E. et al . Anterior chamber contamination during cataract surgery with intraocular lens implantation.  J Cataract Refract Surg. 1997;  23 1064-1069
• 39 Montan P G, Koranyi G, Setterquist H E. et al . Endophthalmitis after cataract surgery: risk factors relating to technique and events of the operation and patient history: a retrospective case-control study.  Ophthalmology. 1998;  105 2171-2177
• 40 Montan P G, Wejde G, Setterquist H. et al . Prophylactic intracameral cefuroxime. Evaluation of safety and kinetics in cataract surgery.  J Cataract Refract Surg. 2002;  28 982-987
• 41 Moshirfar M, Feiz V, Fitale A T. et al . Endophthalmitis after uncomplicated cataract surgery with the use of fourth-generation fluoroquinolones: a retrospective observational case series.  Ophthalmolgy. 2007;  115 686-691
• 42 Motschmann M, Menkhaus S, Kuchenbecker J. et al .Ist der Zusatz eines Antibiotikums zur Spüllösung bei der Kataraktoperation sinnvoll?. Duncker G, Ohrloff C, Wilhelm F 12. Kongress der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation und refraktive Chirurgie 1998 Berlin, Heidelberg, New York; Springer-Verlag 1999: 111-118
• 43 Nagaki Y, Hayasaka S, Kadoi C. et al . Bacterial endophthalmitis after small-incision cataract surgery. Effect of incision placement and intraocular lens type.  J Cataract Refract Surg. 2003;  29 20-26
• 44 O’Brien T P, Arshinoff S A, Mah F S. Perspectives on antibiotics for postoperative endophthalmitis prophylaxis: Potential role of moxifloxacin.  J Cataract Refract Surg. 2007;  33 1790-1800
• 45 Olson R J. Europeans, Americans split over intracameral cefuroxime use. A debate at ESCRS highlighted different attitudes toward intracameral cefuroxime use for cataract surgery prophylaxis.  Ocular Surg News (Europe/Asia-Pacific-Edition). 2008;  Januar 13-14
• 46 Percicot C L, Schnell C R, Debon C. et al . Continuous intraocular pressure measurement by telemetry in alpha-chymotrypsin-induced glaucoma model in the rabbit: effects of timolol, dorzolamide, and epinephrine.  J Pharmacol Toxicol Methods. 1996;  36 223-228
• 47 Rosen E S. Safety first.  J Cataract Refract Surg. 2007;  33 1669-1671
• 48 Samad A, Solomon L D, Miller M A. et al . Anterior chamber contamination after uncomplicated phacoemulsification and intraocular lens implantation.  Am J Ophthalmol. 1995;  120 143-150
• 49 Schröder A C, Schmidbauer J M, Sobke A. et al . Influence of fibronectin on the adherence of Staphylococcus epidermidis to coated and uncoated intraocular lenses.  J Cataract Refract Surg. 2008;  34 497-504
• 50 Sherwood D R, Rich W J, Jacob J S. et al . Bacterial contamination of intraocular and extraocular fluids during extracapsular cataract extraction.  Eye. 1989;  3 308-312
• 51 Shingleton B J, Wadhwani R A, O’Donoghue M W. et al . Evaluation of intraocular pressure in the immediate period after phacoemulsification.  J Cataract Refract Surg. 2001;  27 524-527
• 52 Speaker M G, Menikoff J A. Prophylaxis of endophthalmitis with topical povidone-iodine.  Ophthalmology. 1991;  98 1769-1775
• 53 Speaker M G, Milch F A, Shah M K. et al . Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis.  Ophthalmology. 1991;  98 639-649
• 54 Ta C N, Egbert P R, Singh K. et al . Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery.  Ophthalmology. 2002;  109 2036-2040
• 55 Ta C N, Sinnar S, He L. et al . Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora.  Eur J Ophthalmol. 2007;  17 689-695
• 56 Taban M, Rao B, Reznik J. et al . Dynamic morphology of sutureless cataract wounds – effect of incision angle and location.  Surv Ophthalmol. 2004;  49 62-71
• 57 Taban M, Behrens A, Newcomb R L. et al . Acute endophthalmitis following cataract surgery.  Arch Ophthalmol. 2005;  123 613-620
• 58 Thoms S S, Musch D C, Soong H K. Postoperative endophthalmitis associated with sutured versus unsutured clear corneal cataract incisions.  Br J Ophthalmol. 2007;  91 728-730
• 59 Vasavada V, Raj S M, Vasavada A R. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification observational study.  J Cataract Refract Surg. 2007;  33 1019-1024
• 60 Villada J R, Vicente U, Javaloy J. et al . Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery.  J Cataract Refract Surg. 2005;  31 620-621
• 61 Wallin T, Parker J, Jin Y. et al . Cahort study of 27 cases of endophthalmitis at a single institution.  J Cataract Refract Surg. 2005;  31 735-741
• 62 Wetzel W. Erbium: YAG-Laser-Phakoemulsifikation. Vergleich von 2 verschiedenen Applikationssystemen.  Ophthalmologe. 2001;  98 376-379