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The Effect of Preop Lid Scrubs and Levofloxacin on Eyelid and Conjunctival Cultures Prior to Cataract Surgery

¹ Bucci Laser Vision Institute, Wilkes-Barre, PA, United States

Commercial Relationships: F.A. Bucci, Jr., Santen R; L.M. Amico, None; A. Guerino, None; R. Evans, None.

Abstract

Purpose: To compare the efficacy of lid scrubs and levofloxacin for decreasing the bacterial load of the eyelids and conjunctiva prior to cataract surgery.
Methods: 74 cataract patients were randomized into 4 groups. Group 1 (control) received no levofloxacin and performed no lid scrubs prior to cataract surgery. Group 2 (levo only) used levofloxacin for 2 days pre-op and 1 drop the morning of surgery. Group 3 (lid scrubs only) performed lid scrubs qhs for 2 nights pre-op. Group 4 (levo + lid scrubs) performed lid scrubs qhs x 2 nights and used levofloxacin 4 x day for 2 days preop and on the morning of cataract surgery. Conjunctival and eyelid cultures were obtained preop on the morning of surgery and the results were statistically analyzed.
Results: The lid scrubs only group yielded the highest number of colony-forming units (mean=2493), 47% greater than the control group (mean=1695). The mean colony-forming units for levo alone was 1078, 36% less than the control group. Most interestingly, the mean colony-forming units for the levo + lid scrubs group was 279, 89% less than the lid scrubs only group, 84% less than the control group, and 74% less than the levo alone group. The difference between the control group and the levofloxacin + scrubs group was highly significant (p=.017), as was the difference between the lid scrubs alone and the levo + lid scrubs group (p=.005). The difference between the control group and the levofloxacin group just reached significance at a p-value of .049. A staph species was detected in 100% of specimens in Groups 1, 2, and 3. Staph species were detected in only 50% of specimens in Group 4 (levo + lid scrubs).
Conclusions: The results of this study strongly suggest that performing lid scrubs preoperatively in the absence of a concomitant broad-spectrum antibiotic increases the risk of ocular infection prior to cataract surgery. However, the synergistic combination of lid scrubs and the use of a broad spectrum fluoroquinolone, such as levofloxacin, dramatically reduces the number of conjunctival and eyelid colony-forming units compared to all other methods tested.

Keywords: endophthalmitis • anterior segment • bacterial disease

© 2003, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.