Comparison of the efficacy of povidone–iodine 1.0%, 5.0%, and 10.0% irrigation combined with topical levofloxacin 0.3% as preoperative prophylaxis in cataract surgery

Abstract

No author has a financial or proprietary interest in any material or method mentioned.

Incidence of postoperative endophthalmitis from 1990 to 2009 using povidone–iodine but no intracameral antibiotics at a single academic institution

“…The preset study and the Wykoff et al study 19 support the use of a larger volume and higher concentrations of povidone-iodine. This is in accordance with other studies that used the conjunctival bacterial load as a surrogate marker for the risk for postoperative endophthalmitis [13][14][15] and found a greater reduction in bacterial colonies when higher concentrations or larger volumes of povidone-iodine were used. [13][14][15] In the present study, the risk for postoperative endophthalmitis after cataract surgery declined during the study period.…”

“…This is in accordance with other studies that used the conjunctival bacterial load as a surrogate marker for the risk for postoperative endophthalmitis [13][14][15] and found a greater reduction in bacterial colonies when higher concentrations or larger volumes of povidone-iodine were used. [13][14][15] In the present study, the risk for postoperative endophthalmitis after cataract surgery declined during the study period. Taban et al 20 published a systematic review of English-language articles and found rates of postoperative endophthalmitis of 0.087% in the 1990s and 0.265% from 2000 to 2003.…”

“…However, a greater reduction in the preoperative conjunctival bacterial load has been shown when intensified regimens of preoperative povidone-iodine prophylaxis were used before cataract surgery. [13][14][15] The preoperative conjunctival bacterial load is a surrogate marker of the risk for postoperative endophthalmitis only. Yet it is often used in studies evaluating the effect of different preoperative prophylaxis schemes because infectious endophthalmitis is a rare complication of cataract surgery and studies measuring the direct effect of different preoperative prophylaxis schemes on the rate of postoperative endophthalmitis would require very large numbers of patients and are difficult to perform.…”

“…Yet it is often used in studies evaluating the effect of different preoperative prophylaxis schemes because infectious endophthalmitis is a rare complication of cataract surgery and studies measuring the direct effect of different preoperative prophylaxis schemes on the rate of postoperative endophthalmitis would require very large numbers of patients and are difficult to perform. [13][14][15][16][17] Although using the conjunctival bacterial load as a surrogate parameter is a compromise because it is based on the assumption that an increased number of conjunctival bacteria is associated with a higher risk for postoperative endophthalmitis, the present study gives data on the actual incidence of postoperative endophthalmitis when different preoperative prophylaxis regimens were used. Based on the results in this study, one might conclude that flush irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%, as performed in period 3, is better than the application of 1 drop of povidone-iodine 1.0% (period 2).…”

A Review of Antibiotic Prophylaxis for Post-operative Endophthalmitis

“…This is in accordance with studies that have used reduced conjunctival bacterial load as a surrogate marker for reduced post-operative endophthalmitis. [37][38][39] Antibiotics in the irrigating solution Sobaci et …”