Sub-Conjunctival Injection of Antibiotics vs. Povidone-Iodine Drop on Bacterial Colonies in Phacoemulsification Cataract Surgery

Panahibazaz, Mahamoudreza; Moosavian, Mojataba; Khataminia, Gholamreza; Feghhi, Mostafa; Yazdi, Farsim; Montazeri, Effat Abbasi

doi:10.5812/jjm.13108

Cited by 6 publications

(3 citation statements)

References 23 publications

(82 reference statements)

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“…Some authors have suggested administering it after surgery in order to reduce the flora of the conjunctiva. However, an Iranian randomized clinical trial found similar colony counts for patients receiving povidone-iodine post-operatively and patients treated with sub-conjunctival antibiotics at the end of the surgery [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

et al. 2021

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Background Acute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss. A 10-year study of APE was conducted to determine its incidence, microbiological spectra and antibiotic resistance profile of APE-related pathogens at a major tertiary referral center in Brazil. Methods APE cases reported between January 2010 and December 2019 were included. Phacoemulsification and extracapsular cataract techniques were eligible; combined procedures, traumatic and congenital cataract were excluded. Vitreous samples were cultured and antimicrobial resistance was compared for the periods of 2010–2014 and 2015–2019. The results were analyzed with Fisher’s exact test. Results Our sample consisted of 40,491 cataract surgeries and 51 (0.126%) APE cases. Culture was positive in 35 cases (71.4%), of which 31 (88.6%) Gram-positive, 3 (8.6%) Gram-negative, and 1 (2.9%) fungal. The most frequently isolated organism was Staphylococcus epidermidis (n = 17/35, 48.6%), followed by Staphylococcus aureus (n = 4/35, 11.4%). From 2010–2014 to 2015–2019, antimicrobial resistance increased against moxifloxacin (11.1–54.5%, p = 0.07), ciprofloxacin (54.5–72.7%, p = 0.659) and oxacillin (66.7–93.3%, p = 0.13). Conclusions The observed incidence and microbial spectra were compatible with previous studies. A trend towards growing moxifloxacin and ciprofloxacin resistance was observed. Surveillance remains crucial to prevent treatment failure from antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

et al. 2021

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“… 41 Carrim et al demonstrated that a 3 min treatment with PI decreased the number of positive cultures in patients 42 and a 10% treatment reduced the number of colony-forming units in patients undergoing cataract surgery. 43 The optimum time and concentration of PI to prevent infections is unknown, however, 5% PI decreases bacterial load significantly more than 1% PI in vivo, while in vitro studies indicate the opposite is true with lower PI concentrations appearing to decrease bacterial load more than higher concentrations. 44 45 The finding that even 0.25% PI damages and kills conjunctival cells in the present study highlights the need to determine a minimal, but effective amount and time of contact of PI with the ocular surface to prevent infection with the least amount of cell damage.…”

Section: Discussionmentioning

confidence: 99%

Povidone iodine treatment is deleterious to human ocular surface conjunctival cells in culture

et al. 2020

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ObjectiveTo determine the effect of povidone iodine (PI), an antiseptic commonly used prior to ocular surgery, on viability of mixed populations of conjunctival stratified squamous and goblet cells, purified conjunctival goblet cells and purified conjunctival stromal fibroblasts in primary culture.Methods and analysisMixed population of epithelial cells (stratified squamous and goblet cells), goblet cells and fibroblasts were grown in culture from pieces of human conjunctiva using either supplemented DMEM/F12 or RPMI. Cell type was evaluated by immunofluorescence microscopy. Cells were treated for 5 min with phosphate-buffered saline (PBS); 0.25%, 2.5%, 5% or 10% PI in PBS; or a positive control of 30% H2O2. Cell viability was determined using Alamar Blue fluorescence and a live/dead kit using calcein/AM and ethidium homodimer-1 (EH-1).ResultsMixed populations of epithelial cells, goblet cells and fibroblasts were characterised by immunofluorescence microscopy. As determined with Alamar Blue fluorescence, all concentrations of PI significantly decreased the number of cells from all three preparation types compared with PBS. As determined by calcein/EH-1 viability test, mixed populations of cells and fibroblasts were less sensitive to PI treatment than goblet cells. All concentrations of PI, except for 0.25% used with goblet cells, substantially increased the number of dead cells for all cell populations. The H2O2 control also significantly decreased the number and viability of all three types of cells in both tests.ConclusionWe conclude that PI, which is commonly used prior to ocular surgeries, is detrimental to human conjunctival stratified squamous cells, goblet cells and fibroblasts in culture.

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“… 23 – 26 Furthermore, it has been reported that PVP-I is able to reduce bacterial load and colony counts on the conjunctival surface prior to ocular surgery and that this effect does not alter the constituents which comprise the normal conjunctival flora. 22 , 27 , 28 It should be understood that a reduction of bacterial load, but not bacterial diversity, would be unlikely to promulgate the growth of more virulent bacterial strains. Another important attribute of PVP-I is its ability to destroy the bacterial biofilm.…”

Section: Discussionmentioning

confidence: 99%

Keratoprosthesis prophylaxis: is it time for a paradigm shift?

Pelletier¹,

Barone²,

Capriotti³

2018

OPTH

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The Boston Type I Keratoprosthesis has been improving in both design and safety since its inception. Due to particular features inherent in the Boston Type I Keratoprosthesis eye and certain aspects of the ocular surface, special attention is required to maintain these implanted devices. There is currently a prominent role for keratoprosthesis prophylaxis; it is designed to prevent infectious complications like keratitis and endophthalmitis. This standard-of-care therapy has anecdotally been shown to improve outcomes; however, it has not been examined in the setting of controlled clinical trials. Moreover, concerns remain with the chronic utilization of topical antibiotics in that they may engender antibiotic resistance and select for opportunistic populations to establish a foothold on the ocular surface. We believe and introduce the idea that there is merit in exploring other compounds besides antibiotics for prophylaxis such as antiseptics like povidone-iodine. Specifically developed formulations of povidone-iodine may prove useful in both improving keratoprosthesis safety and simultaneously mitigating concerns regarding antibiotic resistance.

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Sub-Conjunctival Injection of Antibiotics vs. Povidone-Iodine Drop on Bacterial Colonies in Phacoemulsification Cataract Surgery

Cited by 6 publications

References 23 publications

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

Povidone iodine treatment is deleterious to human ocular surface conjunctival cells in culture

Keratoprosthesis prophylaxis: is it time for a paradigm shift?

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