Survival of bacteria on the ocular surface following double application of povidone-iodine before cataract surgery

Abstract

Aims This study assessed the effectiveness of one vs two applications of povidone-iodine in decontaminating the eye before cataract surgery. Methods This was a prospective, interventional study of 52 patients having elective unilateral phacoemulsification cataract surgery in a tertiary care centre. Each patient had two applications of povidone-iodine before phacoemulsification cataract surgery, separated by 10 min. Conjunctival swabs were taken before and after each application and cultured in 5% CO 2 and anaerobically. Statistical analysis was performed using McNemar's test for correlated proportions. Results In all, 15 of 52 (29%) patients had positive cultures before the first application and 21 of 52 (40%) patients had positive cultures after it. This was not statistically significant (P ¼ 0.239). A total of 25 of 52 (48%) patients were culture positive before the second application. This was not statistically significantly different from 10 min earlier (P ¼ 0.423). Six of 52 (12%) patients were positive after the second application (Po0.001). Conclusions We conclude that the initial application of povidone-iodine was not effective in decontaminating the eye. Recontamination did not take place between applications. The difference in the proportion of patients with positive results before and after the second application of povidoneiodine was statistically significant. We infer from this that double application of povidone-iodine before cataract surgery is advisable.

A review of preoperative manoeuvres for prophylaxis of endophthalmitis in intraocular surgery

“…When reviewing PVI solutions, although a single conjunctival wash with 5% solution significantly reduced the number of conjunctival bacterial colonies, a double wash was more effective in postoperative endophthalmitis prevention [30]. Li et al [34] reported that a 10% PVI is more effective in conjunctival sac decontamination than a 5 or 1% solution.…”

“…Stranz et al [30] compared a single wash of the conjunctival sac with 5% PVI before cataract surgery to a double instillation. A second instillation resulted in a significantly decreased CFU count.…”

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

“…The evaluation of 200 conjunctival cultures before anterior segment surgery showed significantly fewer positive cultures when PI 5% was used as irrigation compared to instillation [92]. Also, the repeated application of PI was shown to be significantly more effective compared to a single instillation in a small case series [93]. …”

Comparison of the effects of povidone-iodine 5%, polyhexamethylene biguanide, and chlorhexidine as a preoperative antiseptic in endophthalmitis prophylaxis in patients undergoing phacoemulsification cataract surgery

“…Stranz et al . [ 28 ] compared a single wash of the conjunctival sac with 5% PVI before cataract surgery to a double instillation. A second instillation resulted in a significantly decreased CFU count.…”