State of the microbial spectrum (microbiome) of the ocular surface of patients with cataracts and glaucoma in the early postoperative period

Abstract

Background. The occurrence of infectious complications in the early postoperative period in patients undergoing ophthalmic surgery remains a persistent challenge in contemporary clinical practice. Typically the treatment regimen involves the administration of a combination of antibiotics and corticosteroids, often utilized in a fixed-dose combination for simplicity. Despite the prevalent use of these regimens, there’s a notable disregard for comprehensive microbiological diagnostics of the conjunctiva in surgical patients, attributed to various socio-economic factors. However, the significance of such diagnostics in forecasting postoperative outcomes is indisputable. Purpose of the study: to determine the medical and economic feasibility of prescribing individual antibacterial and anti-inflammatory medications in fixed combinations (FC) in postoperative treatment regimens for patients scheduled ophthalmic surgeries. Materials and methods. The study included data from 99 patients (65 males and 34 females, mean age 74 (70–77) years) admitted for elective surgery to address cataracts or glaucoma from May to September 2023. Patients were randomly divided to 2 observation groups. The division into groups was carried out according to the drugs (medicines) used in the postoperative treatment regimens, each of which was further divided into 2 subgroups in accordance with ophthalmopathology. The first group of patients received postoperative therapy with the levofloxacin/dexamethasone FC (L-dexopt, RK.O. Rompharm Company S.R.L., RU LP-007490), the second group was treated with a tobramycin/dexamethasone FC (Tobrazon, Kadila Pharmaceuticals, RU P№015176/01). All subjects underwent a comprehensive ophthalmological examination, as well as a microbiological examination of the conjunctival cavity before surgery and 8 days after surgical treatment. Additionally, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire. Results. Analysis of microbial flora changes during therapy revealed an increase in cultures exhibiting a “zero” degree of growth by 29 and 11,1 % in the “cataract” and “glaucoma” subgroups of the fi rst observation group, respectively. The second group showed a similar increase. “zero” degree of growth (11,7 and 28,6 %, respectively). The treatment costs for patients undergoing cataract surgery and receiving the FC levofloxacin/ dexamethasone were 105.9 rubles per treatment course, compared to 40.5 rubles for those undergoing surgery for glaucoma or complicated cataracts. The cost-effectiveness for those treated with the FC tobramycin/dexamethasone in the early postoperative period was 21,6 and 51,9 rubles. respectively. The OSDI scores across in all subgroups ranged from 16,6 to 25,0 points indicating normal values. The administration of FC levofloxacin/dexamethasone and tobramycin/dexamethasone in the early postoperative period for patients with cataracts and glaucoma was clinically effectively in managing the inflammatory process by influencing the microbial spectrum (microbiome) of the ocular surface. No significant differences were observed in the degrees of microflora growth during the preoperative period between the “cataract” and “glaucoma” subgroups, which does not support the hypothesis regarding the antiseptic action of topical antiglaucoma medications in patients with glaucoma at this stage. Conclusions. The conducted medical and economic analysis proved the feasibility of using both drug combination with a slight preference FC levofloxacin/dexamethasone in patients undergoing surgery for glaucoma and FC tobramycin/dexamethasone for those with uncomplicated cataracts in the early postoperative period.