Phacoemulsificator and sterile drapes contamination during cataract surgery: a microbiological study

Eur J Ophthalmol. 2012 Mar-Apr;22(2):188-94. doi: 10.5301/EJO.2011.8434.


Purpose: To determine the microbial contamination of the irrigating fluids at the time of phacoemulsification after the use of topical povidone-iodine and antibiotics prophylaxis.

Methods: A total of 119 patients undergoing cataract surgery were enrolled in this prospective study. All patients received 5 mg/mL levofloxacin starting from the day prior to surgery and topical and 5% povidone-iodine drops starting from 30 minutes before the surgery. At the end of each surgery, 2 samples of drainage liquids were sterilely collected from the drainage bags (DBL) and from the peristaltic pump single-cassettes (PCL) of the phacoemulsification machine. Search for aerobic and anaerobic bacteria and fungi was performed.

Results: Seventy-five patients (31.5%) revealed a growth of at least one microbial species (53 DBL and 22 PCL, 44.5% vs 18.5%; p<0.001). Sixty-six patients (55.5%) had at least one positive intraoperative solution. Overall, 111 microbial strains were collected: 82 (74%) Gram-positive bacteria, 20 (18%) fungi, and 9 (8%) Gram-negative bacteria. Thirteen staphylococcal isolates from PCL, compared with 52 out of DBL (11% vs 43.7%, p<0.001), fungi were essentially isolated from PCL. No significant correlation was found between microbial isolation and risk factors. No postsurgical infective complication occurred in the follow-up.

Conclusions: Evaluation of intraoperative fluids can provide evidence on sources or vehicles of postsurgical infections. Antibiotic prophylaxis and topical povidone-iodine can significantly contribute to minimize the risk of endophthalmitis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents, Local / administration & dosage
  • Antibiotic Prophylaxis
  • Bacteria / isolation & purification*
  • Colony Count, Microbial
  • Endophthalmitis / microbiology
  • Endophthalmitis / prevention & control
  • Equipment Contamination*
  • Female
  • Fungi / isolation & purification*
  • Humans
  • Levofloxacin
  • Male
  • Ofloxacin / therapeutic use
  • Ophthalmic Solutions*
  • Phacoemulsification / instrumentation*
  • Povidone-Iodine / administration & dosage
  • Prospective Studies
  • Risk Factors
  • Surgical Drapes / microbiology*
  • Therapeutic Irrigation*


  • Anti-Bacterial Agents
  • Anti-Infective Agents, Local
  • Ophthalmic Solutions
  • Levofloxacin
  • Povidone-Iodine
  • Ofloxacin