Prevention of infection after corneal refractive surgery: a French survey

Abstract

Purpose: To report the French refractive surgeons' real-life practices for preventing infection after corneal refractive surgery (photorefractive keratotomy [PRK], laser in situ keratomileusis [LASIK], and small-incision lenticule extraction). Setting: France. Design: Anonymous practice survey. Methods: The questionnaire was sent in a single email invitation to 400 declared refractive surgeons. The following information was recorded between December 2019 and April 2020, before the coronavirus pandemic: demographics data, preoperative evaluation and preparation of the patient, surgical management, immediate and postoperative protocol, and infections reported after corneal refractive surgery. Results: Eighty-three of 400 surgeons (20.75%) responded to the questionnaire; 55 (66.0%) performed more than 50 corneal refractive surgeries a year, and 25 (30.1%) performed more than 200 procedures a year. Thirty-six (43.4%) surgeons wore 3 protective items, 37 (44.6%) 2, 5 (6.0%) 1, and 5 (6.0%) zero. Seventy-seven (92.8%) surgeons used povidone–iodine for skin area disinfection and 54 (65%) for conjunctival fornix disinfection. The contact time of povidone–iodine was less than 3 minutes for 71 (85.0%) surgeons. Twenty surgeons (24.1%) reported at least 1 postrefractive surgery infection. Twenty percent of surgeons who wore sterile gloves for PRK reported postoperative infections compared with 62.5% for those who did not (P = .008). These figures were, respectively, 8.7% and 66.7% for the use of sterile gloves during LASIK (P = .002); 8.9% of surgeons who wore surgical masks for LASIK reported postoperative infections compared with 50.0% for those who did not (P = .01). Conclusions: Practices are variable among French refractive surgeons. Wearing a surgical mask and sterile gloves during corneal refractive surgery appears to be advisable.

Review of glaucoma management in France

“…Other questionnaires that aimed to characterize the practices of French ophthalmologists have been conducted for the management of diabetic macular edema, 9 exudative AMD, 10 vitreoretinal lymphoma, 11 acute isolated optic neuritis, 12 and the prevention of infections after refractive surgery. 13 The voluntary response rate of approximately 8% of ophthalmologists practicing in France seems satisfactory. The ophthalmologists who responded to the questionnaire had practice patterns similar to official national epidemiological data (DRESS 2020).…”

“…Other questionnaires that aimed to characterize the practices of French ophthalmologists have been conducted for the management of diabetic macular edema, 9 exudative AMD, 10 vitreoretinal lymphoma, 11 acute isolated optic neuritis, 12 and the prevention of infections after refractive surgery. 13…”

Postrefractive infectious keratitis: prevention, diagnosis, management, and prognosis

“…When the contact lenses were cultured postoperatively, 15–18.5% were colonized despite the use of prophylaxis with moxifloxacin [6]. The risk of infectious keratitis post-PRK was 0.017–0.3% [7] and 2.92-fold to 6-fold higher than LASIK [8,9].…”