Chemical Preparation of the Eye in Ophthalmic Surgery

Isenberg, Sherwin J.; Apt, Leonard; Yoshimori, Robert; Khwarg, Steven

doi:10.1001/archopht.1985.01050090092039

Cited by 169 publications

(30 citation statements)

References 11 publications

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“…However, these antiseptics have various disadvantages. Povidone-iodine has a wide antimicrobial spectrum and its diluted solution is widely used as an antiseptic of the ocular surface prior to operation [1, 3, 4]. However, this solution sometimes results in corneal epithelial damage.…”

Section: Introductionsupporting

confidence: 40%

Safety of Ozonated Solution as an Antiseptic of the Ocular Surface prior to Ophthalmic Surgery

et al. 2001

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Purpose: To evaluate the safety of an ozonated solution as an antiseptic of the ocular surface prior to ophthalmic surgery. Methods: In experiment 1, a primary culture of rabbit corneal epithelium was established. Then, 0, 4 and 10 ppm ozonated solution and 1.25% povidone-iodine, respectively, were applied to confluent cells on collagen-coated filter inserts (Millicell-CM^®) for 10 min followed by replacement with fresh medium. The transepithelial electrical resistance (TER), which is a good indicator of cell barrier function, was sequentially measured for 30 min. In experiment 2, adult pigmented rabbit eyes were washed with 20 ml of 4 ppm ozonated solution, 1.25% povidone-iodine solution or saline. Slitlamp examinations were performed before and after washing. Results: In experiment 1, 4 ppm ozonated solution did not change the TER as compared with the control. 10 ppm ozonated solution and 1.25% povidone-iodine similarly reduced the TER values significantly as compared with those of the control and 4 ppm ozonated solution. In experiment 2, 4 ppm ozonated solution and saline showed mild superficial punctate keratitis (SPK) in 8.3% of eyes. However, 1.25% povidone-iodine resulted in mild SPK in 17% of eyes and moderate SPK in 25% of eyes. The prevalence of SPK between two groups was significantly different (p = 0.03). Conclusion: Ozonated solution may be safe and a useful antiseptic of the ocular surface prior to ophthalmic surgery.

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Section: Introductionsupporting

confidence: 40%

Safety of Ozonated Solution as an Antiseptic of the Ocular Surface prior to Ophthalmic Surgery

et al. 2001

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“…This effect has been noted in previous studies where irrigation with normal saline has caused an increase in the number of bacterial species cultured. 24 We have included all culture results in our analysis none the less.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 5% povidone-iodine solution against 1% povidone-iodine solution in preoperative cataract surgery antisepsis: a prospective randomised double blind study

Ferguson

Scott²,

McGavigan³

et al. 2003

British Journal of Ophthalmology

139

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Background/aim: Povidone-iodine (PI, Betadine) is routinely used as a preoperative topical antiseptic in cataract surgery as it has been shown to reduce the incidence of postoperative endophthalmitis. However, the concentration used clinically is variable. In vitro studies have shown that PI is paradoxically more effective at lower concentration. This study was undertaken to determine if this effect was reproducible in vivo. Methods: A prospective randomised double blind study was carried out in the ophthalmic theatre in a district general hospital. 105 patients attending for routine cataract surgery were randomly allocated to have their conjunctival fornices irrigated preoperatively with either PI 1% (group A) or PI 5% (group B). Conjunctival swabs were taken, in identical fashion, both before and 1 minute after irrigation. The number and species of bacterial colonies cultured from each swab was counted. The difference in the median number of bacterial colonies from pre-irrigation to post-irrigation cultures was then compared between the groups. Results: Bacterial cultures were gained from 100 patients (33 male, 67 female, mean age 74 years, range 30-95 years). Group B (5% PI) showed a decrease in median colony forming units (CFU) preirrigation from 100 to 40 CFU post-irrigation (a drop of 60%). This was greater than in group A (1% PI) where the reduction was 120 CFU pre-irrigation to 100 CFU post-irrigation (a drop of 16.7%) (Mann-Whitney test, p<0.05). At higher initial bacterial loads (CFU pre-irrigation >1000), the difference in median between the two groups became larger as the number of pre-irrigation bacteria increased. In group B pre-irrigation CFU reduced from 3340 to 110 post-irrigation (a drop of 96.7%) compared with group A: 5000 CFU pre-irrigation to 3000 post-irrigation (a drop of 40%) (Mann-Whitney test, p=0.0014). Conclusion: Despite in vitro evidence of higher bactericidal efficacy of PI at more dilute concentrations, 5% PI is more effective than 1% PI in decreasing the human conjunctival bacterial flora in vivo, particularly in the presence of heavier initial bacterial load.

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“…The normal flora of the ocular surface and conjunctiva, especially CNS, is well known to produce postoperative inflammation and infections1 3 and is thought to be the main source of contamination. Irrigation of the conjunctiva before and during surgery introduces more micro-organisms from the conjunctival crypts onto the surface 7. Airborne microbes can also be delivered into the AC by means of intraocular lenses 2…”

Section: Discussionmentioning

confidence: 99%

“…It is accepted that preoperative use of povidone-iodine reduces the microbial contamination of the operating field significantly8 9 and was used in this study. Preoperative antibiotics were not used since they have only a limited effect on reducing ocular surface bacteria 10…”

Section: Discussionmentioning

confidence: 99%

Peroperative microbial contamination of anterior chamber aspirates during extracapsular cataract extraction and phacoemulsification

Beigi

Westlake

Mangelschots

et al. 1997

British Journal of Ophthalmology

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Background-The normal conjunctival flora is one of the main sources of intraocular contamination during cataract surgery. The theory that the positive anterior chamber (AC) pressure during phacoemulsification (phaco), and the smaller wound utilised, might reduce the rate of contamination was studied. Methods-The peroperative AC aspirates of 210 consecutive patients undergoing cataract surgery were assessed. In group 1, 100 patients underwent a standard extracapsular cataract extraction (ECCE). In group 2, 110 patients underwent phacoemulsification of the crystalline lens through a scleral tunnel. AC aspirates from the Simcoe irrigation/ aspiration cannula (group 1) and phaco probe (group 2) were collected and microbiological studies performed after direct and enrichment cultures. Results-There were 29 (29%) positives in the ECCE group compared with 22 (20%) positive cultures from AC aspirates in the phaco group. Coagulase negative staphylococcus (CNS) was the commonest contaminant in both groups. Conclusion-Although there was a higher rate of AC contamination during ECCE, the diVerence was not statistically significant (p> 0.10, 2 =2.31). (Br J Ophthalmol 1997;81:953-955) The overwhelming majority of postoperative intraocular infections are caused by an organism that is introduced at the time of the surgery. The major source of intraocular contamination is the conjunctival flora. Organisms enter the anterior chamber (AC) either directly 1 or indirectly by intraocular lenses.

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Chemical Preparation of the Eye in Ophthalmic Surgery

Cited by 169 publications

References 11 publications

Safety of Ozonated Solution as an Antiseptic of the Ocular Surface prior to Ophthalmic Surgery

Safety of Ozonated Solution as an Antiseptic of the Ocular Surface prior to Ophthalmic Surgery

Comparison of 5% povidone-iodine solution against 1% povidone-iodine solution in preoperative cataract surgery antisepsis: a prospective randomised double blind study

Peroperative microbial contamination of anterior chamber aspirates during extracapsular cataract extraction and phacoemulsification

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