Prophylaxis for acute scleral buckle infection using 0.25 % povidone-iodine ocular surface irrigation during surgery

Abstract

To investigate whether repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling surgery minimizes ocular surface bacterial contamination at completion of the procedure. A total of 489 consecutive eyes that underwent scleral buckling at a single institution were categorized into two groups according to the intraoperative ocular surface washing method used during two separate time periods--a group using physiological saline (saline group, 222 consecutive eyes) and a group using 0.25 % povidone-iodine (PI group 267, consecutive eyes). In 37 eyes of each group, ocular surface fluids were sampled at the beginning of surgery and at completion of buckling, and subjected to bacteriological culture. Acute scleral buckle infection occurred in one patient, and was caused by Pseudomonas aeruginosa. The incidence of acute scleral buckle infection was 0.45 % (1/222 eyes) in the saline group, and 0 % in the PI group, with no significant difference (P = 0.4540). The bacterial detection rates in ocular surface fluid at the beginning of surgery were 5.4 % (2/37 eyes) using saline and 8.1 % (3/37 eyes) using povidone-iodine, with no significant difference (P = 0.6433). The rates at completion of buckling were 18.9 % (7/37 eyes) using saline and 0 % (0 eye) using povidone-iodine, with a significant difference (P = 0.0114). Repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling procedure reduced the ocular surface bacterial contamination rate to an extremely low level at completion of buckling, suggesting that this method is useful for the prevention of acute scleral buckle infection.

Intravitreal Injection of 1.25% Povidone Iodine Followed by Vitrectomy Using 0.025% Povidone Iodine Irrigation for Treating Endophthalmitis

“…We have also reported repeated irrigation of the operative field with 0.25% PI to be safe for ocular tissues and highly bactericidal in a wide range of ocular surgeries, including cataract operations,9 vitrectomy,10 and buckling procedures 11…”

Comparison of Povidone-Iodine and Gentamicin Soak as Scleral Buckle Infection Prophylaxis

“…In contrast, the efficacy of 5% Povidone-iodine solution for pre-surgical ocular surface sterilization was demonstrated in 1984 and continues to be the ocular surface sterilization solution of choice for many ophthalmic surgeries today. 7 Additionally, 0.25% povidone-iodine solution as an ocular surface wash after the placement of scleral buckles has been shown to have higher sterilization rate compared to saline wash. 8 Anecdotally, some surgeons have used a dilute solution of povidone-iodine to soak the buckle element prior to placement. To date, no studies have compared the two approaches in terms of antimicrobial efficacy.…”

<p>Bacterial Detection Rate and Surgical Outcome in Povidone-Iodine Irrigation After Nasolacrimal Duct Intubation</p>

“…12 After this report, PI was included in various ophthalmic surgical procedures. [13][14][15][16] A meta-analysis of non-ophthalmic surgical procedures revealed that PI significantly reduces the postoperative infection rate in clean but not in dirty or contaminated wounds. 17 However, the efficacy of PI after intubation surgery has not been reported yet.…”