Reduced anterior chamber contamination by frequent surface irrigation with diluted iodine solutions during cataract surgery

Shimada, Hiroyuki; Arai, Shinji; Nakashizuka, Hiroyuki; Hattori, Takayuki; Yuzawa, Mitsuko

doi:10.1111/aos.13390

Cited by 25 publications

(19 citation statements)

References 28 publications

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“…The incidence of endophthalmitis associated with cataract surgery is less than 0.01% [ 120 ]. Because endophthalmitis following surgery is typically caused by ocular surface organisms, the eyelid and surrounding area are treated with povidone iodine, which kills bacteria within seconds [ 121 ]. Approximately 60% of the cataract surgeons treat their patients with prophylactic antibiotic, a treatment that has been complicated by the resistance of MRSA strains to multiple antibiotics (especially fourth generation fluoroquinolones) and the problem of a rare but severe allergic reaction affecting the retina (hemorrhagic occlusive retinal vasculitis, HORV) when vancomycin is used [ 122 , 123 ].…”

Section: Endophthalmitismentioning

confidence: 99%

The Pathogenesis of Staphylococcus aureus Eye Infections

O’Callaghan

2018

Pathogens

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Staphylococcus aureus is a major pathogen of the eye able to infect the tear duct, eyelid, conjunctiva, cornea, anterior and posterior chambers, and the vitreous chamber. Of these infections, those involving the cornea (keratitis) or the inner chambers of the eye (endophthalmitis) are the most threatening because of their potential to cause a loss in visual acuity or even blindness. Each of these ocular sites is protected by the constitutive expression of a variety of antimicrobial factors and these defenses are augmented by a protective host response to the organism. Such infections often involve a predisposing factor that weakens the defenses, such as the use of contact lenses prior to the development of bacterial keratitis or, for endophthalmitis, the trauma caused by cataract surgery or intravitreal injection. The structural carbohydrates of the bacterial surface induce an inflammatory response able to reduce the bacterial load, but contribute to the tissue damage. A variety of bacterial secreted proteins including alpha-toxin, beta-toxin, gamma-toxin, Panton-Valentine leukocidin and other two-component leukocidins mediate tissue damage and contribute to the induction of the inflammatory response. Quantitative animal models of keratitis and endophthalmitis have provided insights into the S. aureus virulence and host factors active in limiting such infections.

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Section: Endophthalmitismentioning

confidence: 99%

The Pathogenesis of Staphylococcus aureus Eye Infections

O’Callaghan

2018

Pathogens

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“…Shimada et al demonstrated that repeated irrigation with 0.025% PI is effective at reducing the bacterial infections after cataract surgery. 46 It is possible that this technique, which is the only technique known to sterilise the anterior chamber at the conclusion of cataract surgery, may be less toxic to the conjunctiva, while still protecting the eye from bacterial infection.…”

Section: Discussionmentioning

confidence: 99%

Povidone iodine treatment is deleterious to human ocular surface conjunctival cells in culture

et al. 2020

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ObjectiveTo determine the effect of povidone iodine (PI), an antiseptic commonly used prior to ocular surgery, on viability of mixed populations of conjunctival stratified squamous and goblet cells, purified conjunctival goblet cells and purified conjunctival stromal fibroblasts in primary culture.Methods and analysisMixed population of epithelial cells (stratified squamous and goblet cells), goblet cells and fibroblasts were grown in culture from pieces of human conjunctiva using either supplemented DMEM/F12 or RPMI. Cell type was evaluated by immunofluorescence microscopy. Cells were treated for 5 min with phosphate-buffered saline (PBS); 0.25%, 2.5%, 5% or 10% PI in PBS; or a positive control of 30% H2O2. Cell viability was determined using Alamar Blue fluorescence and a live/dead kit using calcein/AM and ethidium homodimer-1 (EH-1).ResultsMixed populations of epithelial cells, goblet cells and fibroblasts were characterised by immunofluorescence microscopy. As determined with Alamar Blue fluorescence, all concentrations of PI significantly decreased the number of cells from all three preparation types compared with PBS. As determined by calcein/EH-1 viability test, mixed populations of cells and fibroblasts were less sensitive to PI treatment than goblet cells. All concentrations of PI, except for 0.25% used with goblet cells, substantially increased the number of dead cells for all cell populations. The H2O2 control also significantly decreased the number and viability of all three types of cells in both tests.ConclusionWe conclude that PI, which is commonly used prior to ocular surgeries, is detrimental to human conjunctival stratified squamous cells, goblet cells and fibroblasts in culture.

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“…16 Diluted PAI is as effective as PI in killing bacteria, and cleaning the ocular surface with PAI every 20 to 30 seconds during cataract surgery has been reported to result in an extremely low rate of bacteria detection in the anterior chamber at the end of surgery, without damage to corneal endothelial cells. 17 In a solution of PI or PAI, free iodine is released which acts directly on the membrane proteins of bacteria and virus to exhibit a microbicidal effect. 11,18,19 However, iodine also has been reported to cause damage to corneal epithelial cells, 20-23 corneal endothelial cells, [23][24][25][26] and retina.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recently, the method of washing the surface of the eye with PI or PAI every 20 to 30 seconds during cataract or vitreous surgery has become widely used mainly in Japan. 9 – 11 , 17 , 19 However, irrigation of the ocular surface with dilute PI or PAI during surgery has a risk of accidentally introducing the solution into the eye. For this reason, it is important to examine the retinal toxicity of iodine in detail.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Retinal Function and Pathology After Intravitreal Injection of Povidone-Iodine and Polyvinyl Alcohol-Iodine in Rabbits

Shimada

Kato²,

Ishida³

et al. 2020

Trans. Vis. Sci. Tech.

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Citation: Shimada H, Kato K, Ishida K, Yamaguchi T, Shinoda K. Evaluation of retinal function and pathology after intravitreal injection of povidone-iodine and polyvinyl alcohol-iodine in rabbits. Trans Vis Sci Tech. 2020;9(5):5, https://doi.org/10. 1167/tvst.9.5.5 Purpose: This study compared intraocular toxicity of intravitreally injected povidoneiodine (PI) and polyvinyl alcohol-iodine (PAI) in rabbits. Methods:In each rabbit, 0.1 mL of PI or PAI solution was injected intravitreally into one eye and saline was injected into the other. PI was tested at available iodine concentrations of 0.05%, 0.1%, 0.2%, and 0.5%, and PAI at 0.05%, 0.1%, and 0.2% (n = 6 each). Electroretinograms were recorded before injection and 1, 7, and 14 days after injection. Pathological examinations of eyeballs were performed on day 15.Results: Mean b-/a-wave ratios of the electroretinograms did not change in eyes injected with 0.05%, 0.1%, or 0.2% PI (PI-0.05, PI-0.1, and PI-0.2, respectively) or in eyes injected with 0.05% or 0.1% PAI (PAI-0.05 and PAI-0.1, respectively) compared to salineinjected eyes, but was transiently impaired on day 1 in PAI-0.2 eyes. Histopathologically, no retinal abnormalities were observed in PI-0.05, PAI-0.05, or PAI-0.1 eyes. One PI-0.1 eye first showed localized inflammatory cell infiltration in the inferior retinal region. Two PI-0.2 eyes and one PAI-0.2 eye had retinal degeneration and inflammatory cell infiltration. In the PI-0.5 group, extensive inflammatory cell infiltration was observed in six eyes and inferior retinal detachment in five eyes.Conclusions: PI and PAI have equivalent retinal toxicity profiles, and retinal toxicity first affects the inner retinal layer in the inferior region. The highest non-retinotoxic vitreous concentration is 0.0033% available iodine from intravitreal injection of PI or PAI containing 0.05% available iodine.Translational Relevance: Low concentrations of PI or PAI can be used to wash the ocular surface during surgery or intravitreal injection to prevent endophthalmitis.

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Reduced anterior chamber contamination by frequent surface irrigation with diluted iodine solutions during cataract surgery

Abstract: In cataract surgery, irrigation every 20 seconds of the operative field with 0.025% PI or 0.0025% PAI, both of which contain 0.0025% available iodine concentration, achieved a very low bacterial contamination rate in the anterior chamber.

Cited by 25 publications

References 28 publications

The Pathogenesis of Staphylococcus aureus Eye Infections

The Pathogenesis of Staphylococcus aureus Eye Infections

Povidone iodine treatment is deleterious to human ocular surface conjunctival cells in culture

Evaluation of Retinal Function and Pathology After Intravitreal Injection of Povidone-Iodine and Polyvinyl Alcohol-Iodine in Rabbits

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