Effectiveness of meibomian gland massage combined with topical levofloxacin against ocular surface flora in patients before penetrating ocular surgery Shao Dan Zhang a, 1 , Jing Na He a, b, 1 , Tong Tong Niu a , Shan Shan Liu a , Chiu Yeung Chan c , Chun Yang Ren d , Chi Liu a , Chi Pui Pang b , Yang Qu a , Ruo Xi Li a , Hai Lin Wang a, * a Department of Ophthalmology, The Fourth People's Hospital of Shenyang, Shenyang Eye Research Institute, Key Laboratory of Ophthalmology of Shenyang, China b Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong c Department of Microbiology, The Chinese University of Hong Kong, Hong Kong d Department of Clinical Laboratory, The Fourth People's Hospital of Shenyang, China article info Article history: Received 17 July 2017 Received in revised form 25 August 2017 Accepted 6 September 2017 Keywords: Microbiology Meibomian gland Preoperative prophylaxis abstract Objective: To investigate the bacterial profile in the conjunctiva and meibomian glands in patients before penetrating ocular surgeries, and to compare the anti-bacterial efficacy of 0.5% levofloxacin and its combination with meibomian gland massage. Design: Hospital-based, case-control study. Participants: Two hundred and twenty-six eyes from 226 patients with non-infective ocular diseases and scheduled for penetrating ocular surgeries. Methods: Tested eyes were administered topical 0.5% levofloxacin (4 times daily) for 2 days. Among them, 91 eyes received meibomian gland massage before levofloxacin application. Samples from the conjunctival sac and meibomian glands were collected for aerobic and anaerobic cultures. Main outcome measures: Culture-positivity and bacterial strains. Results: Before treatment, aerobes and anaerobes were cultured from 38.5% and 11.0% of the conjunctival samples respectively, compared with 38.5% and 8.8% in the meibomian secretions respectively. Staphy- lococcus epidermidis and Propionibacterium acnes were the commonest isolated aerobe and anaerobe. Two-day application of levofloxacin reduced aerobic growth to 29.6% in the conjunctiva and 19.3% in the meibomian glands. It had no effect on the anaerobes in these regions (13.3% in the conjunctiva and 10.4% in the meibomian glands). Combined levofloxacin with meibomian gland massage further reduced aerobic growth to 19.8% in the conjunctiva and 11.0% in the meibomian glands. It also drastically decreased anaerobic growth in the meibomian glands (1.1%). Conclusions: Meibomian glands carrying considerable bacteria should be considered as a potential source of contamination in ocular surgery. Meibomian gland massage shows additional anti-bacterial effects to topical levofloxacin and could be recommended as a complementary preoperative prophylaxis. © 2017 Elsevier Inc. All rights reserved. 1. Introduction Endophthalmitis is an uncommon but serious complication of penetrating ocular surgeries that may lead to visual impairment. Treatment can be difficult. Exogenous endophthalmitis is much more common than endogenous endophthalmitis [1]. Prevalence of postoperative endophthalmitis correlated with cataract surgery is about 0.02e0.197%, 0.03%e1.55% in vitrectomy and 0.02%e0.1% in intravitreous injection [2e9]. Coagulase-negative staphylococci are the most frequently identified bacteria in acute-onset endoph- thalmitis while Propionibacterium acnes is the most common microorganism isolated in delayed-onset endophthalmitis [10e17]. It is commonly perceived that bacterial endophthalmitis often * Corresponding author. Department of Ophthalmology, The Fourth People's Hospital of Shenyang, No.20 Huanghenan Street, Huanggu District, Shenyang, Liaoning 110031, China. E-mail address: wanghailin_syeri@126.com (H.L. Wang). 1 These two authors contribute equally to this work. Contents lists available at ScienceDirect The Ocular Surface journal homepage: www.theocularsurface.com http://dx.doi.org/10.1016/j.jtos.2017.09.001 1542-0124/© 2017 Elsevier Inc. All rights reserved. The Ocular Surface xxx (2017) 1e7 Please cite this article in press as: Zhang SD, et al., Effectiveness of meibomian gland massage combined with topical levofloxacin against ocular surface flora in patients before penetrating ocular surgery, The Ocular Surface (2017), http://dx.doi.org/10.1016/j.jtos.2017.09.001