Prevention of postoperative endophthalmitis.

Prevention of postoperative endophthalmitis (POE) requires (1) environmental control, (2) tissue control, and (3) anticipation of eyes at special risk of infection. Environmental control entails an adequate supply of finely filtered air and absolute sterility of solutions, medications, and objects and materials used during surgery. Tissue control involves degerming the skin of the operative field, inhibition of the flora of the lid margins by an antibiotic ointment use preoperatively, and pretreatment of the conjunctival tear film by soluble antibiotics possessing activity against Proteus and Pseudomonas as well as gram-positive species. Eyes at special risk of infection include those of diabetics, chronic alcoholics, and individuals who have been maintained for long periods of time on systemic or topical corticosteroids. Patients who have had multiple eye operations, recurrent uveitis, and who are scheduled for surgery on the second eye during a single hospital admission should receive special consideration preoperatively.