Strabismus Surgery Infection Prophylaxis and Timing of First Postoperative Visit

Abstract

Purpose: To characterize the practice patterns of pediatric ophthalmologists regarding infection prophylaxis for strabismus surgery and timing of the first postoperative visit. Methods: A ten-question multiple-choice, close-ended questionnaire was e-mailed to members of the American Association for Pediatric Ophthalmology and Strabismus listserv. Survey responses were summarized using frequencies and percentages. Univariable tests of association between prophylactic measures and surgeons reporting a prior episode of postoperative cellulitis or endophthalmitis were performed. Results: Three hundred eighty pediatric ophthalmologists completed the survey. Most ophthalmologists instill 5% povidone-iodine solution during surgical preparation (88.4%), use topical antibiotics with or without steroids at the conclusion of surgery (90%), and prescribe oral or topical antibiotics postoperatively (85.5%). Eighty-five percent of strabismus surgeons routinely see patients for the first postoperative visit within the first week, although there is no consensus as to which day is preferred. Responders previously reporting experience with a postoperative infection were more likely to use intraoperative intravenous antibiotics ( P = .002) and Tegaderm tape (3M, St. Paul, MN) or other adhesive drape to isolate the eyelids/eyelashes ( P = .047). Conclusions: A common practice pattern appears to exist regarding the use of 5% povidone-iodine solution in surgical preparation, application of topical antibiotics at the end of surgery, and a postoperative regimen of topical antibiotics/steroids. There is no prevailing practice pattern regarding the timing of the first postoperative visit. Previous experience with postoperative cellulitis or endophthalmitis may lead to the adoption of more formidable infection prophylaxis measures such as intravenous antibiotics prior to surgery. [ J Pediatr Ophthalmol Strabismus . 2019;56(6):354–359.]

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study

“…A recent multicenter study by DeBenedictis et al investigated practice patterns for infection prophylaxis in pediatric ophthalmic strabismus surgery. Specialists (members of the American Association for Pediatric Ophthalmology and Strabismus) responded to a survey (completed by 380 members) that showed 88.4% use topical administration of 5% povidone iodine during surgical preparation, 90% use topical antibiotics with or without steroids at the end of surgery, and 85.5% prescribe oral or topical antibiotics after surgery [44].…”

Strabismus Surgery: A Retrospective Comparison of Different Postoperative Treatment Regimes to Prevent Infections

“…Based on these findings, we adapted our postoperative treatment in strabismus surgery in 2017 from routine use of topical antibiotics taken over a week to a onetime drop of polyvidone-iodine. However, in 2019, a survey among 380 members of the American Association for Pediatric Ophthalmology and Strabismus revealed that 85.5 % still prescribe oral or topical antibiotics postoperatively [4].…”