SummaryFluid aspirated from the anterior chamber and fluid drained from the conjunctival sac during 101 extracapsular cataract operations was examined for bacterial con tamination. Bacteria were grown by enrichment culture from the conjunctival sac of 90 eyes and from the anterior chamber aspirate of 29 eyes. Conjunctival fluid, stained with fluorescein, was demonstrated to flow into the anterior chamber during the aspiration stage of extracapsular cataract extraction and during intraocular lens implantation. It is suggested that this fluid from the conjunctival sac, contaminated with bacteria, routinely enters the anterior chamber during extracapsular cataract extraction and is the likely source of some cases of post-operative endophthalmitis.

This study describes a dramatic rise in intraocular pressure which occurs within a few hours after cataract surgery without the use of a-chymotrypsin. Early reports stated that intraocular pressures remained low after cataract surgery, but these statements were based on measurements made several days (Hilding, I955) or weeks after surgery (Miller, Keskey, and Becker, 1957). Applanation measurements made I2 hours after surgery were reported at or below the preoperative level (Galin, Baras, and Perry, I96I). Gormaz (i962, 1973) first reported ocular hypertension one day after cataract surgery and did not use oc-chymotrypsin. Giardini and Paliaga (I964) reported ocular hypertension 8 hours after cataract surgery with a technique which included the use of oc-chymotrypsin. The association of this enzyme with a postoperative rise in intraocular pressure was made by Kirsch (I964). Galin, Barasch, and Harris (I966) supported this relationship. However, in those eyes in which o-chymotrypsin had not been used, Kirsch (I964) reported a 23 per cent. and Galin and others (I966) an 8 per cent. incidence of ocular hypertension, by their criteria. Rich ( I 968) demonstrated a consistent rise in intraocular pressure one day after cataract surgery without the use of a-chymotrypsin and with a technique designed to secure water-tight incision closure. He suggested that an early postoperative rise in intraocular pressure followed all cases of cataract surgery in which incision closure was water-tight. MethodsCataract surgery was performed on ten consecutive patients (Cases i to I o) whose eyes were otherwise normal. The age range was 54 to 86 yrs. Preoperative preparation of the patient included one drop of a steroid-antibiotic combination the night before and on the morning of surgery. Preoperative sedation was intramuscular diazepam IO mg. one hour before surgery. No mydriatic or other medication, local or systemic, was used. The operations were performed under local anaesthesia with topical proparacaine o-s per cent. and facial nerve block and retrobulbar anaesthesia with lignocaine 2 per cent. with adrenaline i :iooo and hyaluronidase. The operations were performed by the same surgeon using a surgical microscope.The anterior chamber was entered beneath a limbus-based conjunctival flap through a bevelled comeo-scleral incision; the outer two-thirds of this incision were vertical and the inner portion sharply angled anteriorly. Two corneo-scleral sutures of 25 p diameter Perlon were placed before the chamber was entered. The lens was removed by cryoextraction. a-chymotrypsin was not used. The anterior chamber was then irrigated with a I in 200 solution of acetylcholine, the corneo-scleral sutures were tied, and a basal iridectomy was performed. The corneo-scleral incision was additionally

Background-The normal conjunctival flora is one of the main sources of intraocular contamination during cataract surgery. The theory that the positive anterior chamber (AC) pressure during phacoemulsification (phaco), and the smaller wound utilised, might reduce the rate of contamination was studied. Methods-The peroperative AC aspirates of 210 consecutive patients undergoing cataract surgery were assessed. In group 1, 100 patients underwent a standard extracapsular cataract extraction (ECCE). In group 2, 110 patients underwent phacoemulsification of the crystalline lens through a scleral tunnel. AC aspirates from the Simcoe irrigation/ aspiration cannula (group 1) and phaco probe (group 2) were collected and microbiological studies performed after direct and enrichment cultures. Results-There were 29 (29%) positives in the ECCE group compared with 22 (20%) positive cultures from AC aspirates in the phaco group. Coagulase negative staphylococcus (CNS) was the commonest contaminant in both groups. Conclusion-Although there was a higher rate of AC contamination during ECCE, the diVerence was not statistically significant (p> 0.10, 2 =2.31). (Br J Ophthalmol 1997;81:953-955) The overwhelming majority of postoperative intraocular infections are caused by an organism that is introduced at the time of the surgery. The major source of intraocular contamination is the conjunctival flora. Organisms enter the anterior chamber (AC) either directly 1 or indirectly by intraocular lenses.

Severe glaucoma was controlled in all 13 cases following insertion of a Molteno drain in a single stage procedure. One eye required a repeat operation. A modified technique to minimise early postoperative hypotony and prevent flat anterior chambers is described.

No abstract