Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study

Musumeci, Rosario; Troiano, P.; Martinelli, Marianna; Piovella, Matteo; Carbonara, Claudio; Rossi, Scipione; Alessio, Giovanni; Molteni, Luisa; Molteni, Claudio Giuseppe; Saderi, Laura; Sotgiu, Giovanni; Cocuzza, Clementina

doi:10.3390/jcm10102198

Cited by 11 publications

(7 citation statements)

References 28 publications

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“…Several formulations were used as preoperative prophylaxis prior to cataract surgery. In 2021 Musumeci et al demonstrated that 0.6% PVI eye drop (IODIM, Medivis, Catania, Italy) used for 3 days in patients who underwent cataract surgery were effective in reducing the conjunctival bacterial load [35]. Accordingly, Pinna et al showed that 0.6% PVI eye drop had rapid in vitro antimicrobial activity against common etiologic agents of ocular infection, such as S. epidermidis, S. aureus, and P. aeruginosa [36].…”

Section: Antiseptics and Disinfectantsmentioning

confidence: 99%

“…From this perspective, the evaluation of risk-benefit ratio led us to consider that the use of antibiotics in place of PVI can be considered not justified. Since the safety and effectiveness of PVI has been well acknowledged by several scientific studies [1,35], ocular surgeons can use PVI without the risk of incurring medical claims for not having administered antibiotics.…”

Section: Risk Management Strategiesmentioning

confidence: 99%

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Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

et al. 2023

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In this review we discuss the role of intraocular surgery preoperative prophylaxis. The correct choice of antimicrobial drug is variable in each surgical setting, according to the available strengths of evidence, the anatomical district involved, and the type of procedure. In the ophthalmic surgical field, there has been a progressive shift from antibiotic formulations, which are known to cause antibiotic resistance, to a new class of antiseptic compounds, which proved to be effective not only against bacteria, but also against fungi, protozoa, and viruses. Among these, povidone-iodine (PVI) is a watersoluble polymer that can form a complex with iodine, and the perioperative application of PVI 5-10% eye drop for 3 min is the gold standard for infection prophylaxis. A new formulation of 0.6% PVI eye drop is a new option for infection prophylaxis in the days before surgery. Chlorhexidine is a biguanide compound, which is a valid alternative with a good safety and efficacy profile and is the antiseptic of choice in patients with iodine allergy. New compounds that are currently being studied include polyhexamethylene biguanide (PHMB), picloxydine, ozone, hypochlorous acid (HOCl), and Biosecur. PHMB is a biguanide polymer that was found to be more effective than PVI in in vitro studies for reducing microorganisms and extending the duration of antisepsis, but to date, there are no formulations available on the market for preoperative ocular surgery in which it is present as main ingredient. Ozone is a molecule with oxidizing effect, which showed interesting preliminary results but is not effective against virus, Staphylococcus aureus and Candida albicans. HOCl has a natural bactericidal propriety but its applicability to prophylaxis of ocular infection in the setting of ocular surgery is not established. Biosecur is a non-toxic organic alcohol-free compound that exhibited

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Section: Antiseptics and Disinfectantsmentioning

confidence: 99%

Section: Risk Management Strategiesmentioning

confidence: 99%

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

et al. 2023

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“…In order to avoid the adverse event, there are some registered preventive actions for endophthalmitis, such as the use of 0.66% povidone-iodine eye drops before surgery [28] . Or use of intracameral antibiotics during surgical procedures [29,21] can be considered as a preventive approach to infections.…”

Section: Discussionmentioning

confidence: 99%

Major outbreak of endophthalmitis after cataract surgery: a retrospective cohort in northern Brazil

Pereira¹,

Sabini²,

Almeida³

et al. 2023

Preprint

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Background: Endophthalmitis is one of the most important adverse events after cataract surgery as it can lead to total vision loss. The aim of this study was to describe the occurrence of endophthalmitis after phacoemulsification with intraocular lens implantation among patients assisted during a joint effort in Porto Velho, Rondonia, Brazil. Method: This is a retrospective cohort study, carried out from a bank with 649 medical records of patients who underwent surgery. Descriptive analysis and multiple analysis using Robust Poisson Regression were performed to estimate relative risks (RR) and 95% confidence intervals (95%CI). A statistical analysis was performed using the statistical program Stata version 16.0 (College Station, Texas, USA). Results: The incidence of postoperative endophthalmitis confirmed by culture was 10.88%, the highest ever recorded in the world. A higher risk for endophthalmitis was found, in probable cases, among males (RR: 1.88; 95%CI:1.03; 3.44) and brown and yellow skin color (RR: 2.78; 95 %CI %: 1.17; 6.60). For confirmed and probable cases, bilateral surgery and specific lens model were also risk factors. The predominant etiological agents were gram-negative and the main clinical manifestation was corneal edema. The average number of days to start treatment was eight days and 27.12% used antibiotics. Conclusion: Specific protocols are needed for cataract surgeries that encompass hiring, performing and monitoring these services to ensure good practices and patient safety.

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“…26 Here, our results also supported that 0.5% PVP-I was already beneficial for POE prophylaxis for effectively reducing the risk of POE, which was consistent with the conclusion in Rosario’s study. 27 It seems that a low concentration PVP-I might realize financial savings as well as improved antisepsis at the same time, which is worth promoting. However, further large-scale randomized controlled trials were needed to evaluate the optimum concentration of PVP-I.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Prophylaxis and Prognosis of Acute Postoperative Endophthalmitis After Cataract Surgery: A Multicenter Retrospective Analysis in Northern China from 2013 to 2019

Jiang¹,

Yu²,

Yuan³

et al. 2022

IDR

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To investigate the incidence of acute postoperative endophthalmitis (POE) after cataract surgery in Northern China from 2013 to 2019, evaluate the efficacy of prophylaxis and analyze the predictors of visual prognosis among POE patients. Methods: The study was conducted as a retrospective multi-center research, with seven hospitals in Northern China enrolled. The diagnosis of acute-onset POE was made on the basis of clinical manifestations within six weeks after initial surgery. By reviewing electronic medical system, the number of cataract surgeries and acute POE cases were recorded to estimate the overall incidence and incidences by different years and hospitals. Perioperative measures for preventing infection in different hospitals were collected. The correlations between unfavorable final vision and potential factors including basic information and clinical characteristics were examined to determine the predictive factors for final visual prognosis. Results: Of 72,255 cataract surgeries performed during seven years in the seven hospitals, 19 cases developed acute POE, yielding an overall incidence of 0.026%. The average incidence of acute POE among seven hospitals significantly declined annually during the past 7 years (p = 0.021). In Hospital-D, the incidence of acute POE significantly decreased after the application of 0.5% povidone-iodine (PVP-I) for conjunctival washing (p = 0.003). Two hospitals adopting tobramycin in the irrigation solution achieved a significant lower incidence of POE than the other hospitals (p = 0.044). The positive rate of pathogen culture was just 17.6% (3/19). Patients with presenting BCVA of CF or better were more likely to present with unfavorable final vision than those with worse presenting BCVA (p = 0.003). Conclusion:The overall incidence of acute POE after cataract surgery from 2013 to 2019 in Northern China was 0.026%, and the incidence declined annually over the period. Presenting BCVA could be a significant prognosis factor for predicting the final visual outcomes of acute POE patients.

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Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study

Cited by 11 publications

References 28 publications

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

Major outbreak of endophthalmitis after cataract surgery: a retrospective cohort in northern Brazil

Incidence, Prophylaxis and Prognosis of Acute Postoperative Endophthalmitis After Cataract Surgery: A Multicenter Retrospective Analysis in Northern China from 2013 to 2019

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