Preoperative antisepsis in ophthalmic surgery (a review)

Zaharia, Alexandra-Cătălina; Dumitrescu, Otilia-Maria; Rogoz, Roxana-Elena; Dimirache, Andreea Elena; Zemba, M

doi:10.22336/rjo.2021.25

Cited by 8 publications

(6 citation statements)

References 23 publications

(33 reference statements)

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“…It should be emphasized that the surgical disciplines are also those most involved in HAIs related medical malpractice cases. In intraocular procedures, infectious endophthalmitis due to bacterial or fungal infection is a potentially devastating complication [30,84]. Furthermore, a study showed that ophthalmic surgery had a significant litigation/conviction ratio (83.3%), much higher compared with other branches.…”

Section: Risk Management Strategiesmentioning

confidence: 99%

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

et al. 2023

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In this review we discuss the role of intraocular surgery preoperative prophylaxis. The correct choice of antimicrobial drug is variable in each surgical setting, according to the available strengths of evidence, the anatomical district involved, and the type of procedure. In the ophthalmic surgical field, there has been a progressive shift from antibiotic formulations, which are known to cause antibiotic resistance, to a new class of antiseptic compounds, which proved to be effective not only against bacteria, but also against fungi, protozoa, and viruses. Among these, povidone-iodine (PVI) is a watersoluble polymer that can form a complex with iodine, and the perioperative application of PVI 5-10% eye drop for 3 min is the gold standard for infection prophylaxis. A new formulation of 0.6% PVI eye drop is a new option for infection prophylaxis in the days before surgery. Chlorhexidine is a biguanide compound, which is a valid alternative with a good safety and efficacy profile and is the antiseptic of choice in patients with iodine allergy. New compounds that are currently being studied include polyhexamethylene biguanide (PHMB), picloxydine, ozone, hypochlorous acid (HOCl), and Biosecur. PHMB is a biguanide polymer that was found to be more effective than PVI in in vitro studies for reducing microorganisms and extending the duration of antisepsis, but to date, there are no formulations available on the market for preoperative ocular surgery in which it is present as main ingredient. Ozone is a molecule with oxidizing effect, which showed interesting preliminary results but is not effective against virus, Staphylococcus aureus and Candida albicans. HOCl has a natural bactericidal propriety but its applicability to prophylaxis of ocular infection in the setting of ocular surgery is not established. Biosecur is a non-toxic organic alcohol-free compound that exhibited

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Section: Risk Management Strategiesmentioning

confidence: 99%

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

et al. 2023

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“…Even though the type of surgery did not seem to impact the ocular distribution in general, the treatments that are administered preoperatively could influence the interplay between a drug product and the eye surface. Topical antisepsis [ 29 ], topical or regional anesthesia [ 30 ], and topical antibiotics [ 31 ] are used together or in sequence to avoid pain during surgery and post-operative complications. These drugs are typically administered topically in the days and hours that precede the surgery for the antibiotics, the hour before the surgery for the anesthetics, and right before the incision for the antisepsis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Ocular Exposure Extrapolation for Ophthalmic Solutions Using PBPK Modeling and Simulation

et al. 2022

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Background The development of generic ophthalmic drug products is challenging due to the complexity of the ocular system, and a lack of sensitive testing to evaluate the interplay of physiology with ophthalmic formulations. While measurements of drug concentration at the site of action in humans are typically sparse, these measurements are more easily obtained in rabbits. The purpose of this study is to demonstrate the utility of an ocular physiologically based pharmacokinetic (PBPK) model for translation of ocular exposure from rabbit to human. Method The Ocular Compartmental Absorption and Transit (OCAT™) model within GastroPlus® v9.8.2 was used to build PBPK models for levofloxacin (Lev), moxifloxacin (Mox), and gatifloxacin (Gat) ophthalmic solutions. in the rabbit eye. The models were subsequently used to predict Lev, Mox, and Gat exposure after ocular solution administrations in humans. Drug-specific parameters were used as fitted and validated in the rabbit OCAT model. The physiological parameters were scaled to match human ocular physiology. Results OCAT model simulations for rabbit well described the observed concentrations in the eye compartments following Lev, Mox, and Gat solution administrations of different doses and various administration schedules. The clinical ocular exposure following ocular administration of Lev, Mox, and Gat solutions at different doses and various administration schedules was well predicted. Conclusion Even though additional case studies for different types of active pharmaceutical ingredients (APIs) and formulations will be needed, the current study represents an important step in the validation of the extrapolation method to predict human ocular exposure for ophthalmic drug products using PBPK models.

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“…Povidone-iodine (PI), another oxidative system-based disinfectant, has been used on the eye surface prior to intraocular surgery because of its broad-spectrum antibacterial properties and low cytotoxicity to human tissues. 37 CL care products should be able to reduce the number of bacteria that cause these illnesses. The results of a standalone test (EN ISO 14729) on the microbicidal activity of six CL care solutions, Aosept Plus, which contains 3% H2O2, demonstrated a reduction factor of >5 log units for bacteria and >4 for fungi in all cases.…”

Section: Efficiency Of the Existing Mps Productsmentioning

confidence: 99%

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2024

imjm

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Since the past decades, the prevalence of microbial keratitis (MK) has risen notably among contact lens (CL) wearers. The main contributor to this infection is the use of an inefficient CL disinfecting solution. This paper highlights a systematic review of articles from journals on the multipurpose solution (MPS) of CL ingredients available currently in the market. This review emphasizes the compositions of MPS to evaluate their effectiveness and risks to lens wearers. A search for original articles published was conducted through Scopus, PubMed, and Google Scholar databases, focusing on the keywords contact lens ingredients and preservatives, MPS, polyquaternium, biguanides, and MK. A thorough review was conducted to extract the data on the subjects from the generated searches. The review revealed that hydrogen peroxide (H2O2), polyhexamethylene biguanide (PHMB), povidone-iodine (P-I), and polyquaternium-1 (PQ -1) are the preferred MPS formulations in the current industry of CLs. These chemical ingredients are effective against causative agents of keratitis for faster disinfection and lower risks of microbial infections in CL users. Thus, proper hygienic practices must follow the guidance from the respective product manufacturers to prevent harmful risks of ocular diseases.

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Preoperative antisepsis in ophthalmic surgery (a review)

Cited by 8 publications

References 23 publications

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management

Clinical Ocular Exposure Extrapolation for Ophthalmic Solutions Using PBPK Modeling and Simulation

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