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Ocular surgery patients advised
to avoid risk of infection by staying away from swimming pools
Laszlo Dosa in San Francisco, US
OCULAR surgery patients would do well to avoid recreational swimming
for weeks if not months postoperatively to minimise exposure to
water-borne pathogens, say Florida researchers.
At the annual meeting of the American Society of Cataract and Refractive
Surgery, researchers from the Bascom Palmer Eye Institute in Miami
presented a study of pathogenic microorganisms found swimming in
pool and ocean water.
The researchers studied 18 species of microorganisms in ocean water
samples and nine species in samples taken from swimming pools. They
found that potentially all of them could be pathogens, some quite
virulent and infectious, and others just opportunistic.
They cross referenced the microorganisms found in the samples with
the Bascom Palmer registry of eye infections, a database going back
22 years. The research team found pathogenic species associated
with ocular infection in samples of water taken from swimming pools,
hot tubs and the ocean.
The survey revealed quite a high prevalence of Mycobacterium chelonae
and Mycobacterium fortuitum in the tap water, which is used to fill
swimming pools and hot tubs.
"We found that 46% of the pools we sampled have this Mycobacterium
chelonae fortuitum complex. The reason this organism in important
is that delayed corneal infections after LASIK are associated with
Mycobacterium chelonae fortuitum," Ninel Z Gregori MD told
EuroTimes.
Dr Gregori noted that LASIK patients with corneal infection from
Mycobacterium chelonae fortuitum are at risk of delayed onset keratitis
from a few days to a few months after surgery.
"It seems that LASIK patients can acquire this pathogen for
months after surgery. That’s something we should think about
and we advise patients to be careful about going into the water
and rubbing their eyes and doing things that might introduce these
bacteria in their eyes," she stressed.
Half of the hot tubs sampled had high bacterial loads of pseudomonas.
This is a particular concern for contact lens wearers, who are known
to be at increased risk of pseudomonas infection. Micro-abrasions
in the cornea and in the conjunctiva from the friction of the contact
lens open the way for bacteria to enter into the eye easily.
The Bascom Palmer researchers recommend that contact lens wearers
be very cautious about using hot tubs and ensure that there is adequate
chlorination in the water.
Trabeculectomy patients who swim in the ocean or in pools could
also be at increased risk of infection. While more study needs to
be done, it would seem that there is a risk for any patients who
have had surgery of leaving the conjunctival layer non-intact.
"That would put them at increased risk from eye infection for
a limited time in the immediate postoperative period. Mitomycin
C makes the conjunctiva much thinner and could allow easy access
of bacteria into the eye and cause blebitis or endophthalmitis.
We feel that the glaucoma patients who underwent trabeculectomy
surgery and a thin conjunctiva are at increased risk from infection,"
Herbert P Fechter MD said.
He explained that the current study would provide the groundwork
for additional research regarding the risk of swimming to glaucoma
patients who have undergone surgical procedures.
A study now in the planning stages will look specifically at glaucoma
patients who have thin avascular blood and who swim in a bid to
determine whether they are at an increased risk of either endophthalmitis
or blebitis, Dr Fechter said.
There is currently a lack of consensus on what is considered a minimal
period for ocular surgery patients to abstain from swimming, with
recommendations ranging from days to weeks. Dr Fechter’s recommendation
is that ocular surgery patients should avoid contaminated tap water
for at least 72 hours after surgery.
"The skin cells over the eye heal very quickly, unless they
have something like a glaucoma filtering procedure with a thin avascular
blood from a trabeculectomy. Those are at increased risk indefinitely,"
he added.
Water is obviously not sterile even if it is chlorinated. People,
especially post-surgical patients, should be aware of this fact
and take precautions, keeping their head out of the water, not rubbing
their eyes in the pool, Dr Gregori added.
The Bascom Palmer researchers note that patients’ use of well-fitting
swimming goggles can limit ocular irritation and preserve the eye’s
naturally protective tear film.
The tears’ lysozymes, B-lysin and lactoferrin serve as a first
line defense against bacterial invasion. Goggles also prevent the
dilution of the tear film and reduce the risk of potentially pathogenic
bacteria from reaching the eye.
Ninel
Z Gregori MD
Bascom Palmer Eye Institute, Florida, US
Email: ngregori@med.miami.edu
Herbert P Fechter MD
Bascom Palmer Eye Institute, Florida, US
Email: fechter@pol.net
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