Bacterial Contamination of the Anterior Chamber During Phacoemulsification Cataract Surgery

J Cataract Refract Surg. 2002 May;28(5):826-33. doi: 10.1016/s0886-3350(01)01160-9.


Purpose: To determine the incidence of bacterial contamination of the anterior chamber after phacoemulsification cataract surgery with intraocular lens (IOL) implantation.

Setting: Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia.

Methods: Ninety-eight consecutive eyes of 96 patients having phacoemulsification cataract surgery with IOL implantation were included in this prospective study. Two intraoperative anterior chamber aspirates were obtained from each patient, 1 taken at the start and the other at the conclusion of surgery. In addition, preoperative and postoperative conjunctival swabs were acquired. The 4 specimens were cultured using direct culturing techniques under aerobic and anaerobic conditions for 14 days. No preoperative antibiotics were used.

Results: The incidence of intraoperative anterior chamber contamination was 0% (95% confidence interval, 0%-3.7%) as all intraoperative anterior chamber samples proved culture negative. Sixty-five percent of the preoperative conjunctival swabs were positive for growth, with corynebacteria, coagulase-negative staphylococci, and Propionibacterium acnes being the most frequently cultured organisms. Sixteen percent of the postoperative conjunctival swabs were positive for growth, with corynebacteria and coagulase-negative staphylococci being the most common bacteria. One patient developed culture-positive postoperative endophthalmitis; using pulsed-field gel electrophoresis for further typing, the implicated Staphylococcus epidermidis was indistinguishable from that isolated from the patient's preoperative conjunctival swab.

Conclusions: The bacterial contamination rate of the anterior chamber after phacoemulsification and IOL implantation was extremely low. Additional findings support the conjunctiva as being a primary source of bacteria causing postoperative endophthalmitis as well as the ability of povidone-iodine to reduce the conjunctival bacterial load.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anterior Chamber / microbiology*
  • Bacteria / isolation & purification
  • Conjunctiva / microbiology
  • Endophthalmitis / microbiology*
  • Eye Infections, Bacterial* / etiology
  • Female
  • Humans
  • Incidence
  • Intraoperative Complications / microbiology*
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Phacoemulsification / adverse effects*
  • Prospective Studies