Sutureless cataract surgery can be sterile surgery

Objective: Previous reports have shown that aqueous contamination may occur in up to 44% of patients undergoing extracapsular cataract extraction, We investigated prospectively the incidence of aqueous contamination after phacoemulsification and posterior chamber intraocular lens implantation performed through a 7-mm scleral tunnel, Methods: Forty-eight consecutive patients undergoing cataract surgery were included in this study. A conjunctival smear was obtained on the day before surgery and resulted negative for the presence of bacteria in all cases, At the beginning of surgery, the eye surface was irrigated with a 5% povidone iodine solution (Betaisodona(R)). Fluid (0.1-0.2 ml) was aspirated from the anterior chamber through a side entry immediately before opening the scleral tunnel and after lens implantation. The samples were cultured for bacteria (aerobic and anaerobic) and fungi, Results: Coagulase negative Staphylococci could be demonstrated in two samples obtained before opening the scleral tunnel, most likely the result of incorrect sample handling, No positive cultures could be recovered from the fluid aspirated at the end of surgery. Conclusions: As opposed to what was published by other authors in the past, no aqueous contamination could be demonstrated at the end of surgery in any patient included in our study, The use of gentamicin in the irrigating solution and/or the different surgical technique (scleral tunnel approach and phacoemulsification) employed may play a major role in eliminating the possibility of anterior chamber contamination at the time of cataract surgery, Also preoperative evaluation of the conjunctival microbial flora as well as careful disinfection of the ocular surface could be contributory factors.