Abstract
The development of endophthalmitis is as serious a postoperative complication as any that can occur following cataract surgery. In the majority of such cases, there is perma nent loss of useful vision; frequently the globe is lost. Although the incidence of postoperative infection has been quite low in all series re ported, various special procedures, in addi tion to aseptic techniques, have been advo cated and utilized in an attempt to eliminate post-operative infection. Among these meth ods a r e : (1) routine preoperative conjunctival cultures, (2) use of preoperative antibiotics,' (3) subconjunctival injection of penicillin and streptomycin. Several authors have studied the inci dence of postoperative endophthalmitis in large series of cataract extractions. Allen and Mangiaracine reviewed the major series from 1898 to 1960 and found an inci dence of 59 infections in 27,926 cases ( 0 . 2 1 % ) . Various series in which no preop erative antibiotic prophylaxis was used show an occurrence of infection of 0.49% in 2,508 extractions (Locatcher-Khorazo and Gutierrez) ; 0.57% in 6,137 cases (Callahan) ; 1.01% in 2,086 cases (Hughes and Owens 6 ) . Allen and Mangiaracine's series, in which routine topical antibiotics were employed in 19,340 cases, had a 0.06% incidence of en dophthalmitis, suggesting to these authors that prophylactic topical antibiotics should be routinely employed for protection against infection. However, Pearlman's postopera tive infection rate of 0 .51% in 1,773 cases with preoperative topical antibiotics and Lo catcher-Khorazo and Gutierrez's rate of 0 .81% in 7,602 cases with similar preopera tive topical antibiotics suggest that there is no significant improvement over series in which no antibiotic prophylaxis was used. In spite of preoperative cultures and/or preoperative topical antibiotics, there has been no large series of lens extractions without some incidence of postoperative en dophthalmitis. The first series of cataract extractions en tirely free of infection was reported by Pearlman who gave a subconjunctival in jection of penicillin-streptomycin at the con clusion of the operation in 3,226 cataract cases and no case of endophthalmitis oc curred. The purpose of the present paper is to present another series of cataract opera tions (1,212 cases) without any postopera tive infection (table 1) . Every patient in this series was given a subconjunctival in jection of 200,000 units of crystalline peni cillin mixed with either 20,000 units of strep tomycin or 20 mg of colymycin.* Subconjunctival antibiotics have been uti lized in every cataract operation I have per formed during the past 10 years. The anti biotic mixture is injected under the inferior bulbar conjunctiva at the conclusion of the operation. Penicillin was employed in every case, even in 52 patients (table 2) who re ported a penicillin sensitivity (although in these cases with apprehension). Fortunately, there were no instances of immediate reac tion to the injection. Only 11.5% of the pa tients reportedly allergic to penicillin experi enced an abnormal reaction, but no reaction was damaging to the eye or caused more than temporary discomfort to the patient. T w o of the patients presumed allergic to penicillin were given an intradermal skin test. There was no reaction in one patient and a three-plus reaction (test done on the second postoperative day) in the other pa tient who, however, showed no excessive eyelid or conjunctival reaction.
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