Wound complications following cataract surgery. A case-control study

OBJECTIVE

To determine whether selected preoperative medical, social, or behavioral factors predict the occurrence of cataract wound complications.

PATIENTS AND METHODS

Patients who underwent cataract surgery at a Veterans Administration hospital were used in a case-control study. Cases were defined by the occurrence of any postoperative cataract wound gape with or without iris prolapse within 12 weeks of surgery and requiring repair in the operating room. Controls were patients who had no postoperative complications. Two controls were selected for each case patient and matched for surgeon.

RESULTS

Thirty-one patients with postoperative wound complications occurred after 2041 cataract extractions (1.5%). Occurrence of wound complications was predicted by previous hematologic disorder (odds ratio, 2.9; 95% confidence interval, 1.1-8.1). Phacoemulsification surgery had a protective effect against wound complication (odds ratio, 0.2; 95% confidence interval, 0.09-0.64). There was no difference in final visual acuity and refractive indexes in patients with and without wound complications (P = .6 by Student t test).

CONCLUSIONS

Most medical social and behavioral preoperative factors have limited discriminatory power in predicting who will have postoperative cataract wound complications. The association of previous hematologic disorders to predict the occurrence of wound complications varied with the level of alcohol use. Although this study was not primarily designed to assess the role of surgical technique, phacoemulsification cataract extraction had a statistically significant protective effect against wound complications. Visual outcome in patients with postoperative wound complications is generally very good.

Transmission of toxoplasmosis by renal transplant

Two renal allograft recipients who had received their organs from the same cadaver donor developed acute toxoplasmosis shortly after transplantation. Neither of the recipients had serologic evidence of previous exposure to Toxoplasma gondii at the time of surgery, but the donor had a positive indirect fluorescent antibody test. One of the recipients died during the fourth week, and multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite could be found in the transplanted kidney. In the second recipient the disease was suspected, serologically demonstrated, and successfully treated. We concluded that toxoplasmosis was transmitted by the donor's kidneys, although this mode of transmission was not completely proven.

Effectiveness of two new cephalosporins, cephazolin and cephapirin, administered intermittently in acute and chronic osteomyelitis in children

Ten patients were treated, most of pre-school age, with acute osteomyelitis, produced by Staphylococcus aureus and Salmonella, having evolved for approximately one week, with sodium cephazolin at doses of 60 mg/kg/day intramuscularly in two daily injections for the first seven days and then in a single dose every twenty-four hours for four to seven weeks. Nine of ten patients were asymptomatic six months after this treatment. The patient who manifested chronic signs at the end of six weeks of therapy continued to be treated with three weekly injections of the same drug at an equal dose until the completion of six months, at the end of which he was asymptomatic. Ten patients with chronic osteomyelitis having evolved for two months to five years, due to penicillin-resistant Staphylococcus aureus, were treated with cephapirin at the dose of 30 mg/kg in one daily injection intramuscularly for three to four weeks and then the same dose on Mondays, Wednesdays and Fridays until the completion of six months. Eight patients who required it were sequestrectomized. Seven of the ten patients improve and remained asymptomatic for the same period of observation. The three patients who did not show marked clinical improvement did exhibit an appreciable radiological recovery. We have presented these regimens of treatment with a view of encouraging research into the intermittent administration of bactericidal antibiotics for pyogenic infections; in spite of the good results, we do not dare to recommend them in daily practice.