Abstract

P 226

Is an additional application of 10% povidone iodine effective in reducing the conjunctival bacterial load of patients undergoing cataract surgery?

M. Rajab1, Martin M. Nentwich1, Yazmin Yactayo-Miranda1, Lisa He2, Arnd Gandorfer1, Anselm Kampik1, Herminia Mino de Kaspar1
1Augenklinik der Ludwig-Maximilians Universität München, München, 2Department of Ophthalmology, School of Medicine, Stanford, CA, United States

Objective
Postoperative endophthalmitis is a rare but potentially devastating complication of intraocular surgery. Previous studies have shown that povidone-iodine (PVI) is a safe and effective agent in reducing the number of bacteria on the ocular surface at the time of surgery. However, the various methods of applying PVI preoperatively have not been previously studied prospectively. Recommendations differ between the application of single drops of PVI and irrigation of the conjunctival sac.
In this study the efficacy of 10% PVI drops in addition to routine irrigation of the conjunctival sac with 1% PVI was examined.
Methods
In this prospective study on in- and out-patients undergoing cataract surgery, participants were randomized into Group 1 (standard pre-treatment with 1% PVI irrigation) and Group 2 (additional pre-treatment with 10% PVI eye-drops) after informed consent and according to the protocol approved by the Institutional Review Board. All 70 outpatients received neomycin eye drops the hour before surgery while all 91 in-patients received four times one drop of neomycin the day prior to the intervention. During preoperative preparation, all eyes were first disinfected periorbitally with 10% PVI. In Group 1 eyes were subsequently irrigated with 10 mL of 1% PVI just before surgery, while in Group 2 patients were given (in addition to the treatment of Group 1) 3 drops of 10% PVI 10 minutes before surgery. Conjunctival specimens were collected and inoculated in thioglycolate broth at 37ºC for 5 days at the several time-points: T1 - upon arrival in the operation room, T2 - after PVI disinfection, before surgery, T3 - post-surgery. In this study, we forewent to do baseline cultures, as other studies show a culture-positivity in 70-80% of cases. In all positive cultures, bacteria were isolated, identified and the results compared between the groups.
Results
After PVI disinfection, the number of positive cultures was significantly reduced. (p < 0,0006) from 60-90% to 14-24% in all groups. An additional application of 3 drops PVI 10% did not result in a statistically significant further reduction in positive cultures in any group.
Conclusions
The addition of 3 drops of 10% PVI before surgery to a prophylactic regime consisting of antibiotic application and irrigation with 10 mL of 1% PVI did not result in any statistically significant additional benefits in the reduction of conjunctival bacterial load in either group.

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