Postoperative endophthalmitis after cataract surgery: a worldwide review of etiology, incidence and the most studied prophylaxis measures

Grzybowski, Andrzej; Koerner, Jagger C.; George, Mary

doi:10.1080/17469899.2019.1674140

Cited by 10 publications

(7 citation statements)

References 93 publications

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“…In cataract surgery, repetitive application of dilute 0.25% povidone-iodine produces extremely low levels of bacterial contamination in the anterior chamber at the conclusion of surgery [31]. Shimada and colleagues found that in 404 consecutive cataract surgeries, the anterior chamber contamination rate in eyes repetitively irrigated with dilute povidone-iodine was 0%, compared with 5% for eyes treated with single application povidone-iodine.…”

Section: Evidence In Favor Of Low-concentration Povidone-iodinementioning

confidence: 99%

Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

Grzybowski

Shimada

Nakashizuka

et al. 2021

Current Opinion in Ophthalmology

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Purpose of reviewEndophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface. Recent findingsPovidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy. SummaryPovidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrugresistant bacteria, fungi, and lack of inducible resistance. Keywords antisepsis, endophthalmitis, povidone-iodine]. An alternative povidone-iodine dosing scheme, the repetitive application of dilute povidone-iodine throughout surgery, could be helpful. We review the basic science, in vitro, and clinical data regarding this practice. Povidone-iodine is universally available, inexpensive, and the ocular surface is routinely washed with physiologic saline during many ophthalmic surgeries. These characteristics make the barriers to adopting frequent dilute povidone-iodine irrigation low. Therefore, surgeons' exposure to, and interpretation of the literature regarding this practice is particularly important. THE ROLE OF POVIDONE-IODINE IN THE PREVENTION OF OCULAR INFECTIONSNonpathogenic bacteria (resident bacteria) colonize the ocular surface and periocular skin. Under

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Section: Evidence In Favor Of Low-concentration Povidone-iodinementioning

confidence: 99%

Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

Grzybowski

Shimada

Nakashizuka

et al. 2021

Current Opinion in Ophthalmology

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“…Preoperative antisepsis with povidone-iodine significantly decreases the rate of bacterial endophthalmitis and is a worldwide accepted strategy (5,(23)(24)(25)(26). Following conjunctival cul-de-sac irrigation with 5% povidoneiodine prior to surgery, the conjunctival flora undergoes a reported ~60% reduction, especially of coagulase-negative staphylococci (20,27).…”

Section: Povidone-iodinementioning

confidence: 99%

“…For the ocular surface, lower concentrations of povidone iodine administered as frequent applications during surgery are also shown to be effective in preventing contamination of the anterior chamber. Shimada et al reported 0.25% povidoneiodine to be effective in this regard, in conjunction with antibiotic prophylaxis (20,26,30). Topical povidone-iodine may cause toxicity to the corneal epithelium.…”

Section: Povidone-iodinementioning

confidence: 99%

Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update

et al. 2020

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Improved surgical techniques have led to an increase in the number of outpatient ophthalmic procedures. In spite of decreased surgical times and overall improved outcomes, endophthalmitis remains one of the most severe complications of ophthalmic surgery. Although there are well known risk factors for postoperative endophthalmitis, some prophylaxis strategies remain controversial. A category of noninfectious postoperative inflammation, known as toxic anterior segment syndrome (TASS), is a rare but important complication of cataract surgery. While several worldwide outbreaks of TASS have occurred, it is challenging to identify an etiology in order to reduce the risk of further cases. Endophthalmitis and TASS cannot be prevented completely, but their rates may be decreased through risk reduction strategies supported by peerreviewed evidence. This review highlights the current evidence in the prevention strategies for postoperative endophthalmitis and TASS.

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“…Still, precautions should continue for a month to six weeks in cases of SBCS. The role of intracameral antibiotics in preventing endophthalmitis is well documented and its use is also recommended in SBCS (98).…”

Section: Guidelines and Rules For Sbcsmentioning

confidence: 99%

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

Singh¹,

Grzybowski²

2020

Ann Transl Med

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The debate on role of 'simultaneous bilateral cataract surgery' (SBCS) continues. The world population has exponentially increased during last fifty years and average human lifespan has increased by a decade during the last century. This translates to ever increasing geriatric population with its inherent problem of preventable blindness because of cataract formation in the elderly. We are adding to the backlog of cataract surgeries not only in the 'developing world' but also in the 'developed world.' Times demand that we reconsider our old fashioned approach of staggering bilateral cataract surgeries. Serious, but a potential, risk of simultaneous bilateral infection/endophthalmitis has been the biggest deterrent in acceptance of SBCS as a routine procedure. The opponents of SBCS strongly believe in this argument that has not been documented when strictly followed the recommendations regarding separate procedures of each eye. The advantages of reducing the ever-increasing backlog of preventable/treatable blindness, faster visual recovery, economic benefits to patients as well as health care providers, lesser risk of amblyopia in pediatric population, and decreased risk of as serious a complication as death by exposure to general anesthesia in pediatric and adult population, etc. outweigh the disadvantages of SBCS when compared with 'delayed bilateral cataract surgery' (DBCS). SBCS is favored over DBCS in pediatric population and in uncooperative, mentally retarded and physically disabled adults needing general anesthesia to reduce the risks and complications of general anesthesia. Considering such factors and review of available literature strongly support that SBCS has a definite role where indicated, under certain circumstances, and in certain select group of patients in both developing as well as developed countries.

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Postoperative endophthalmitis after cataract surgery: a worldwide review of etiology, incidence and the most studied prophylaxis measures

Cited by 10 publications

References 93 publications

Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

Postoperative Endophthalmitis and Toxic Anterior Segment Syndrome Prophylaxis: 2020 Update

Evolution of and developments in simultaneous bilateral cataract surgery. Update 2020

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