povidone-iodine and Endophthalmitis

Endophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface.. Povidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy.. Povidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrug-resistant bacteria, fungi, and lack of inducible resistance.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; COVID-19; Endophthalmitis; Humans; Postoperative Complications; Povidone-Iodine; SARS-CoV-2

Povidone-iodine (PVI) is a disinfectant and antiseptic agent used for preoperative preparation of the skin and mucous membranes, as well as for the treatment of contaminated wounds. Currently regimens for prophylaxis against postsurgical endophthalmitis are being modified, including a total withdrawal of antibiotics in intravitreal injections. The aim of this study was to evaluate the use of PVI in ophthalmology.. As a result of its broad spectrum of microbicidal activity, PVI is routinely used in ophthalmic surgery. However, various protocols are applied worldwide and within different procedures. Additional indications include prophylaxis against ophthalmia neonatorum, acute conjunctivitis, adenoviral conjunctivitis, bacterial keratitis or corneal ulcer, endophthalmitis, giant fornix syndrome, and antimicrobial prophylaxis in patients with Boston type I keratoprosthesis.. Despite the introduction of new antiseptics in surgery, PVI is still the preeminent antiseptic measure in ophthalmology. Its use is economically reasonable. There have been no reports of resistance to PVI or anaphylaxis with topical ophthalmic use. Furthermore, it does not induce resistance or cross-grztance to antibiotics. With these advantages the range of indications for topical use of antibiotics might decrease, with PVI as the sole perioperative antiseptic measure. Additional studies are required to assess the optimal timing, concentration and exposure time within different ophthalmic procedures.

Topics: Administration, Topical; Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Humans; Ophthalmologic Surgical Procedures; Ophthalmology; Povidone-Iodine; Surgical Wound Infection

Postoperative endophthalmitis is an ophthalmic surgeon's most feared complication, as it portends a high probability of visual loss. The purpose of this article is to review the literature on the subject of preoperative measures used for prevention of postoperative endophthalmitis and to determine the effectiveness of these measures.. The present reviewed literature regarding topical prophylaxis of endophthalmitis in cataract surgery.. There is strong evidence for the use of povidone-iodine preoperatively for prophylaxis of postoperative endophthalmitis in ocular surgery; the evidence for topical antibiotics is not as compelling.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Humans; Postoperative Complications; Povidone-Iodine

To summarize current understanding of antibiotic prophylaxis in cataract surgery, with particular emphasis on available evidence and change in practice patterns over the past decade.. Povidone-iodine application prior to cataract surgery remains a universal practice, and is backed by good quality evidence. Subsequent to the results of the European multicenter trial documenting decreased risk of endophthalmitis with intracameral cefuroxime injection at the end of surgery, similar benefit with intracameral antibiotic use has been reported in studies with large sample sizes from multiple centers around the world. There has been a distinct change in practice patterns in many countries, with intracameral antibiotic use becoming part of routine protocol. In the USA, topical fluoroquinolone application remains the most popular mode of antibiotic prophylaxis. A promising approach is the development of novel drug delivery methods like polymeric devices designed for sustained antibiotic release.. Based on current evidence, the recommended measures for endophthalmitis prophylaxis are preoperative topical instillation of povidone-iodine and intracameral antibiotic injection at the end of cataract surgery.

Topics: Administration, Topical; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Cefuroxime; Endophthalmitis; Eye Infections; Humans; Injections, Intraocular; Postoperative Complications; Povidone-Iodine; Therapeutic Irrigation

To review techniques that are important in preventing endophthalmitis following intravitreous injections based on the available evidence.. A review of the literature regarding existing evidence that is relevant to post-injection endophthalmitis prophylaxis.. The available evidence regarding endophthalmitis prophylaxis is largely based on intraocular surgery, particularly cataract surgery. Despite the controversy and the paucity of evidence regarding endophthalmitis prophylaxis for intravitreous injections, it is recommended that povidone-iodine should be used prior to intravitreous injections to minimize or eliminate the presence of ocular surface bacteria. Administration of topical antibiotics may also be considered before and after the intravitreous injections. Strict adherence to aseptic techniques, including the use of an eyelide speculum is also important.. Endophthalmitic can occur following intravitreous injections. Prophylaxis with topical povidone-iodine, and possibly antibiotics, as well as adherence to aseptic technique may minimize the risk of post-injection endophthalmitis.

Topics: Anti-Bacterial Agents; Endophthalmitis; Eye Infections; Humans; Injections; Povidone-Iodine; Risk Factors; Vitreous Body

To assess commonly used cataract surgery bacterial endophthalmitis prophylaxis techniques based on a systematic literature review and evidence rating.. Prophylactic techniques to decrease the risk of bacterial endophthalmitis related to cataract surgery are commonly used, but the evidence justifying their use is unclear.. A MEDLINE search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. Eighty-eight peer-reviewed papers were identified and judged worthy of review on the basis of predefined criteria.. No prophylactic technique received the highest of three possible clinical recommendations (A, crucial to clinical outcome). Preoperative povidone-iodine preparation received the intermediate clinical recommendation (B, moderately important to clinical outcome). All other reported prophylactic interventions, including postoperative subconjunctival antibiotic injection, preoperative lash trimming, preoperative saline irrigation, preoperative topical antibiotics, antibiotic-containing irrigating solutions, and the use of intraoperative heparin, received the lowest clinical recommendation (C, possibly relevant but not definitely related to clinical outcome) based on weak and often conflicting evidence justifying their use.. With regard to bacterial endophthalmitis prophylaxis in cataract surgery, current literature most strongly supports the use of preoperative povidone-iodine antisepsis.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Databases, Factual; Endophthalmitis; Evidence-Based Medicine; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine

To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone.. A randomized, triple-blind clinical trial.. patients scheduled for intravitreal injections for maculopathy.. any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL).. percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection.. Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54-91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups (p < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant (p > .05).. Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.

Topics: Adolescent; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Chloramphenicol; Conjunctiva; Endophthalmitis; Female; Humans; Intravitreal Injections; Male; Middle Aged; Netilmicin; Pilot Projects; Povidone-Iodine

Topical povidone-iodine (PI) is widely used as an ocular surface antiseptic for intravitreal injections (IVIs). Although PI is generally well tolerated, it can be associated with significant ocular irritation. Aqueous chlorhexidine (AqCHX) has been described as a possibly better tolerated antimicrobial for ophthalmic procedures. We compared patient pain scores, ocular surface characteristics, and antimicrobial efficacy between PI 5% and AqCHX 0.1% during IVIs.. Prospective single-center, randomized clinical trial.. Patients receiving same-day bilateral intravitreal anti-vascular endothelial growth factor (VEGF) injections.. Each patient had 1 eye randomized to PI or AqCHX, and the second eye received the other agent. Both eyes received topical proparacaine 0.5%.. After IVIs, participants rated their pain (Wong-Baker, scale 0-10) for each eye 1 minute after PI or AqCHX instillation and 1 day after the procedure. Each eye was assessed using a standardized quantitative grading system of corneal epitheliopathy (ocular staining score). Microbial swab cultures of the conjunctiva both before instillation of topical antisepsis and 10 minutes after IVIs were given.. A total of 100 eyes of 50 patients were included. The mean patient age was 68 years (range, 39-92), and 30 of 50 (60%) were male. Compared with AqCHX, eyes receiving PI had a greater mean pain score immediately after injection (1.44 vs. 0.44, P < 0.001) but not on postprocedure day 1 (1.04 vs. 0.48, P = 0.06). Eyes that received PI had a higher ocular staining score indicating worse corneal epitheliopathy (4.22 vs. 3.10, P < 0.001). There was no difference in rates of positive microbial cultures between groups. There was no difference in rates of adverse events between groups (P = 0.99), and no cases of endophthalmitis occurred.. Povidone-iodine demonstrated greater ocular surface discomfort and corneal epitheliopathy compared with AqCHX during same-day bilateral IVIs. The 2 agents otherwise demonstrated no difference in positive microbial cultures or adverse events. Aqueous chlorhexidine may be a better tolerated alternative to PI for antimicrobial prophylaxis during IVIs for some patients.

Topics: Aged; Anti-Infective Agents, Local; Antisepsis; Aqueous Humor; Chlorhexidine; Drug Administration Routes; Endophthalmitis; Eye Infections, Bacterial; Female; Follow-Up Studies; Humans; Intravitreal Injections; Male; Povidone-Iodine; Prospective Studies; Treatment Outcome

This report provides updated endophthalmitis rates for eyes receiving intravitreous injections with and without povidone-iodine and rates with and without topical antibiotics from Diabetic Retinopathy Clinical Research Network clinical trials.. Among 8 Diabetic Retinopathy Clinical Research Network clinical trials conducted from 2006 to 2015, 28 786 intravitreous injections were administered (3123 eyes), and 20 617 of those (2264 eyes) were administered between 2012 and 2015. Eleven cases of endophthalmitis occurred; 4 occurred between 2012 and 2015. Thirteen injections in 3 eyes from 2 participants were administered without povidone-iodine; both participants developed endophthalmitis in 1 eye. Of the remaining 28 773 injections (3120 eyes) performed with povidone-iodine, 9 cases of endophthalmitis occurred: 6 cases (0.05% of 11 565 injections) in eyes receiving topical antibiotics and 3 cases (0.02% of 17 208 injections) in eyes not receiving topical antibiotics (P = .17).. While only a small number of eyes did not receive povidone-iodine just prior to an intravitreous injection, this report provides further evidence regarding the risk of endophthalmitis when povidone-iodine is not used before intravitreous injections. Exclusion of topical antibiotics was not associated with a higher risk of endophthalmitis. Continued use of povidone-iodine and consideration to eliminate topical antibiotics from injection procedures seems warranted.

Topics: Administration, Topical; Anti-Bacterial Agents; Canada; Diabetic Retinopathy; Endophthalmitis; Humans; Incidence; Intravitreal Injections; Povidone-Iodine; Prognosis; Retrospective Studies; United States

To determine the time necessary for 5% povidone-iodine (PI) to cause a significant reduction in colony-forming units and whether a lid speculum increases the conjunctival flora.. This was a prospective randomized study of 131 eyes undergoing intravitreal injection. Conjunctival samples were collected in a prospective protocol at three points before intravitreal injection: (1) no intervention (baseline), (2) after placement of a lid speculum, and (3) after treatment with 5% PI. Participants were randomized into three different PI exposure intervals. Cultures were incubated for 6 days, and the resulting colony-forming units were tallied for each intervention.. Use of 5% PI caused significant decrease in the number of colony-forming units (P < 0.0001). Exposure to PI for 15 seconds did not cause a significant reduction in conjunctival bacteria (P = 0.08), but a significant reduction was observed after 30 seconds of exposure and beyond (P = 0.0003). Placement of a lid speculum did not result in a significant increase or decrease in the number of colony-forming units when compared with baseline (P = 0.47).. The use of 5% PI causes a significant reduction in bacterial colonies, and 30 seconds of exposure appears to be an adequate time to decrease conjunctival bacterial counts. Lid speculum use before intravitreal injection does not affect the overall conjunctival flora.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Colony Count, Microbial; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Time Factors

To compare the efficacy of povidone-iodine 1.0%, 5.0%, and 10.0% in combination with topical levofloxacin 0.3% in reducing the preoperative conjunctival bacterial load before cataract surgery.. Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.. Randomized clinical trial.. This study enrolled patients scheduled for cataract surgery between July 2010 and January 2011. All patients received topical levofloxacin 0.3% 4 times on the preoperative day and were randomly assigned to these study groups: Group 1 (povidone-iodine 1.0%), Group 2 (povidone-iodine 5.0%), and Group 3 (povidone-iodine 10.0%). In all groups, the conjunctiva was flush irrigated with 10 mL of povidone-iodine of the respective concentration. Conjunctival specimens were obtained at 4 timepoints: baseline (no-surgery eye), before povidone-iodine irrigation, after povidone-iodine irrigation, and at the end of surgery. All specimens were inoculated onto blood and chocolate agars and into thioglycolate broth.. The study was completed by 271 patients. In the control smear (no-surgery eye), no significant difference in positive cultures was found. After 10 mL povidone-iodine irrigation, a considerable reduction in the conjunctival bacterial load occurred in all groups. The difference in positive cultures was statistically significant between Group 1 and Group 3 (P=.024) and between Group 2 and Group 3 (P=.029). Coagulase-negative Staphylococcus was the most commonly isolated bacteria in all groups.. Povidone-iodine 10.0% was more effective than povidone-iodine 1.0% and 5.0% in decreasing the conjunctival bacterial load before surgery.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteria; Bacterial Load; Bacteriological Techniques; Cataract Extraction; Conjunctiva; Drug Therapy, Combination; Endophthalmitis; Female; Humans; Levofloxacin; Male; Povidone-Iodine; Prospective Studies; Therapeutic Irrigation; Treatment Outcome

To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery.. Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium.. Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%).. The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.

Topics: Administration, Ophthalmic; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aqueous Humor; Bacteria; Bacterial Load; Cataract Extraction; Ciprofloxacin; Conjunctiva; Drug Resistance, Microbial; Endophthalmitis; Female; Humans; Male; Microbiota; Middle Aged; Postoperative Complications; Povidone-Iodine; Preoperative Care; Prospective Studies; Single-Blind Method; Surgical Wound Infection

To compare the effect of a reduced concentration (1.25 %) of povidone-iodine (PI) eye drops, combined with 0.5 % topical levofloxacin (LVFX), with that of the standard of care (5 % PI) on conjunctival flora before intravitreal injections (IVT).. A prospective, randomized, single-blind clinical trial. One hundred eyes from 100 patients who underwent IVT were included. Eyes were randomly assigned to two groups and underwent different preparatory procedures before therapeutic IVT. LVFX drops were instilled three times every 5 min and then either 1.25 % PI drops were instilled three times every few minutes in group A or 5 % PI drops were instilled three times every few minutes in group B, the control. Conjunctival flora and the injection needles were collected for culture both before and after preparation. The number of positive cultures, the species isolated, and the minimum inhibitory concentrations (MIC) of the antibiotics were assessed.. The pretreatment culture was positive for 45 eyes (86.5 %) in group A (n = 52) and for 37 eyes (77.1 %) in group B (n = 48). After the preparatory procedure, the cultures were positive for 25 eyes (48.1 %) in group A and for 27 eyes (56.3 %) in group B (P = 0.43). After preparation, the number of positive cultures decreased by 46.7 % in group A and by 33.4 % in group B (P = 0.48). No needle samples were contaminated in either group. The most common isolate in both groups after preparation for surgery was Propionibacterium acnes. Among the different antibiotics, vancomycin and oxacillin had the lowest MIC >90 for overall isolates.. 1.25 % PI with LVFX is as effective as 5 % PI. P. acnes was the most common conjunctival flora detected. Vancomycin has been confirmed as the best choice for treating infectious endophthalmitis after IVT.

Topics: Angiogenesis Inhibitors; Anti-Infective Agents, Local; Antibodies, Monoclonal, Humanized; Bacteria; Bevacizumab; Conjunctiva; Disinfection; Drug Therapy, Combination; Endophthalmitis; Humans; Intravitreal Injections; Levofloxacin; Microbial Sensitivity Tests; Ofloxacin; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Ranibizumab; Single-Blind Method; Treatment Outcome

To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery.. Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups.. Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain.. More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery.

Topics: Anti-Infective Agents, Local; Bacteria; Bacterial Load; Endophthalmitis; Equipment Contamination; Eyebrows; Eyelashes; Humans; Needles; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Strabismus; Sutures

To compare the sterilization effectivity of topical povidone-iodine, ciprofloxacin, and ofloxacin on the conjunctival bacterial flora.. One hundred sixty-four eyes of 164 patients scheduled for cataract surgery were prospectively analyzed. Conjunctival cultures were obtained 1 day before the surgery without any topical application in all patients. Conjunctival flora was examined in 53 eyes of 53 patients (Group I) 15 min after 5% topical povidone-iodine application on the day of the surgery. Fifty-four eyes of 54 patients (Group II) received 1 drop 0.3% ciprofloxacin at 12 pm 1 day before the operation and 4 drops at 15 min intervals on the day of the surgery. Another 57 eyes of 57 patients (Group III) received 0.3% ofloxacin in the same application mode as ciprofloxacin. Conjunctival cultures were taken in all patients 15 min after last drop of topical antibiotic application.. Only coagulase-negative staphylococci were isolated from 75.4% in Group I, 72.2% in Group II, and 59.6% in Group III on pretreatment culture. Different types of bacteria such as Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Proteus spp., Micrococcus spp. were identified in other patients. Pretreatment conjunctival flora of Group I and Group II were similar (P>0.05), but it was significantly different in Group III (P<0.05). After topical application no bacterial growth was observed in 77.3% in Group I, 92.5% in Group II, and 66.6% in Group III. The difference between Group I and III was insignificant (P>0.05), but bacterial eradication effectiveness was significantly higher in Group II than that of other groups (P<0.05). Post-treatment cultures showed same bacterial flora as pretreatment cultures in 14.9% in Group I, 1.8% in Group II, and 19.2% in Group III. The difference between Group I and Group III was statistically insignificant (P>0.05) and the difference between Group II and other groups was statistically significant (P<0.05). Four eyes (7.5%) showed different types of bacterial growth from pretreatment flora in Group I, which were seen in 3 eyes (5.5%) in Group II and in 8 eyes (14%) in Group III. The differences between groups were statistically insignificant (P>0.05).. Ciprofloxacin seems to be more effective in conjunctival sterilization. In consideration with high variety of bacterial flora in pretreatment period in ofloxacin group, ofloxacin seems to be superior to povidone-iodine on the reduction of bacterial flora on the conjunctiva.

Topics: Administration, Ophthalmic; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Conjunctiva; Endophthalmitis; Female; Fluoroquinolones; Humans; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; Povidone-Iodine; Prospective Studies; Sterilization; Treatment Outcome

We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection.. Prospective, randomized single-blind clinical trial.. We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University.. Study patients were randomized to self-administration of gatifloxacin drops for 3 days before injection, or no pretreatment antibiotics. Cultures were collected from the bulbar conjunctiva at the injection site and at the corresponding location in the fellow eye before PVI preparation. After topical PVI treatment and immediately before injection, a third culture was obtained at the injection site. Additionally, the injection needle was also cultured after the procedure.. Incidence of positive bacterial samples collected from injection site conjunctiva and injection needles.. Three-day gatifloxacin use resulted in a significantly lower rate of SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures compared with untreated controls (21% vs 48% respectively, P = 0.005). After topical PVI, the rate of positive bacterial cultures in gatifloxacin-treated and control eyes were similar (8% and 4%, respectively; P = 0.324).. Although 3-day topical gatifloxacin use is effective in reducing the frequency of conjunctival bacterial growth relative to untreated eyes, antibiotic use confers no additional benefit in combination with PVI than eyes receiving PVI alone. This supports that topical PVI is an effective preinjection monotherapy for infection prophylaxis in the setting of IVT injections.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacteria; Colony Count, Microbial; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Female; Fluoroquinolones; Gatifloxacin; Humans; Injections; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Single-Blind Method; Vitreous Body

To report the incidence of endophthalmitis after intravitreal drug injection by means of a standardized procedure that does not require topical antibiotics, sterile gloves, or a sterile drape.. Intravitreal injections of preservative-free triamcinolone acetonide or ranibizumab were administered in 2 prospective randomized clinical trials performed by the Diabetic Retinopathy Clinical Research Network. The standardized procedure for these trials requires the use of a topical combination product of povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require the use of topical antibiotics before, on the day of, or after injection.. As of February 23, 2009, a total of 3226 intravitreal injections of ranibizumab and 612 injections of preservative-free triamcinolone had been administered. Topical antibiotics were given on the day of injection in 361 (9.4%) of the 3838 cases, for several days after injection in 813 cases (21.2%), on the day of injection and after injection in 1388 cases (36.2%), and neither on the day of injection nor after injection in 1276 cases (33.3%). Three cases of culture-positive endophthalmitis occurred after ranibizumab injections (0.09%), and no cases occurred after triamcinolone injections. In all 3 cases of endophthalmitis, topical antibiotics were given for several days after the injection but not before injection.. The results suggest that a low rate of endophthalmitis can be achieved by means of a protocol that includes use of topical povidone-iodine, a sterile lid speculum, and topical anesthetic, but does not require topical antibiotics, sterile gloves, or a sterile drape. Trial Registration clinicaltrials.gov Identifiers: NCT00444600 and NCT00445003.

Topics: Anesthetics, Local; Angiogenesis Inhibitors; Anti-Bacterial Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Disinfection; Endophthalmitis; Eye Infections, Bacterial; Glucocorticoids; Humans; Incidence; Injections; Laser Coagulation; Macular Degeneration; Methicillin-Resistant Staphylococcus aureus; Povidone-Iodine; Prospective Studies; Ranibizumab; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Triamcinolone Acetonide; Vascular Endothelial Growth Factor A; Viridans Streptococci; Vitreous Body

To compare the efficacy of topical levofloxacin in combination with povidone-iodine irrigation vs povidone-iodine (PVI) alone in reducing conjunctival bacteria.. Prospective, randomized, controlled trial.. One hundred and forty eyes of 140 patients scheduled to undergo intraocular surgery eyes were randomized to either group 1 or 2 (70 each). Whereas group 1 eyes had no prophylactic antibiotic, eyes in group 2 received topical treatment with one drop of 0.5% levofloxacin four times on the day before surgery. Both groups underwent irrigation of the fornices with 1% PVI. Conjunctival swabs were inoculated on solid and broth culture media to determine bacterial growth.. Of 132 eyes evaluated, baseline culture analysis in thioglycolate demonstrated positive culture results in 55 (84.6%) of 65 eyes from group 1, similar to 55 (82.1%) of 67 eyes in group 2 (P = .697). Before surgery, 57 (87.7%) of 65 eyes in group 1 had positive culture results, compared with 50 (74.6%) of 67 eyes in group 2 (P = .055). After irrigation with PVI, 20 (30.8 %) of 65 eyes in group 1 had positive culture results, compared with only eight (11.9%) of 67 eyes in group 2 (P = .008). After surgery, 15 (23.1%) of 65 eyes in group 1 and six (9.0%) of 67 eyes in group 2 had positive culture results (P = .027).. Our study shows an enhanced effect of using topical levofloxacin in combination with PVI irrigation to reduce conjunctival bacteria in patients undergoing intraocular surgery.

Topics: Administration, Topical; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteria; Bacteriological Techniques; Cataract Extraction; Colony Count, Microbial; Conjunctiva; Drug Therapy, Combination; Endophthalmitis; Female; Glaucoma; Humans; Keratoplasty, Penetrating; Levofloxacin; Male; Ofloxacin; Ophthalmic Solutions; Postoperative Complications; Povidone-Iodine; Prospective Studies; Treatment Outcome; Vitrectomy

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Bacteria; Colony Count, Microbial; Conjunctiva; Endophthalmitis; Humans; Ophthalmologic Surgical Procedures; Povidone-Iodine; Prospective Studies; Time Factors

To study bacteria from eye lids and conjunctival sac of patients undergoing cataract surgery before and after the application of antiseptics.. Patients undergoing elective cataract extraction in one university hospital were randomly enrolled. Cultures for bacteria and candida were done by swabbing the eye lids before and after cleaning with 4% chlorhexidine gluconate. Subsequently 10% povidone iodine was applied on eye lids and conjunctival sacs. Cultures of specimens from eye lids and conjunctival sac were taken after the application of 10% povidone iodine and at the end of the operation.. Fifty-one patients were enrolled. Positive cultures were found in 90.2% and 82.4% before and after cleaning the face with 4% chlorhexidine. After topical application of 10% povidone iodine, only 19.6% had positive cultures from eye lids and conjunctival sac; a significant reduction (p=0.001). At the end of the operation, positive cultures were found from eye lids in 10 patients and from the conjunctival sac in 4 patients. Isolates were skin flora and candida species in 2 patients. None of the patients had endophthalmitis.. Cleaning eye lids with 4% chlorhexidine followed by applying 10% povidone iodine was effective in decreasing skin flora in cataract surgery. The organisms were not completely eliminated. Postoperative follow-up to detect infectious complications is warranted.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Cataract Extraction; Chlorhexidine; Conjunctiva; Endophthalmitis; Eyelids; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Postoperative Care; Povidone-Iodine; Prospective Studies; Time Factors; Treatment Outcome

To investigate whether the use of topical povidone-iodine before surgery, the addition of vancomycin to the irrigating solutions during phacoemulsification, or both reduces the frequency of positive intraocular cultures at the end of surgery.. A two-part, clinical study was performed. In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 11 eyes) and 2 hours after surgery (in 11 eyes) in patients treated with vancomycin. In the primary study, 400(1) patients were divided into four groups composed of 100 eyes each. The first and the second groups received vancomycin (20 microg/ml) in the irrigating fluid. The third and the fourth groups received irrigating fluid only without antibiotics. The first and third groups received a topical 5% povidone-iodine solution 10 and 5 minutes before surgery; a topical placebo solution was used in the second and the fourth groups. All patients in the primary study underwent anterior chamber aspiration after surgery, and culturing was performed 2 hours later. Identification and quantification of positive cultures in thioglycolate broth and chocolate agar were performed.. In the preliminary study, the half-life of intraocular vancomycin was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in two (2%), five (5%), 11 (11%), and 13 (13%) specimens from the first, second, third, and fourth groups, respectively.. We found a lower rate of positive cultures in the group that received vancomycin in the irrigating fluid; 2 hours of contact between the antibiotic solution and bacteria produced results that reached statistical significance (P = 0.032).

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Aqueous Humor; Bacteria; Biological Availability; Double-Blind Method; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Half-Life; Humans; Male; Middle Aged; Phacoemulsification; Povidone-Iodine; Vancomycin

A multicentre study of a new preparation of povidone iodine (5% betadine) was carried out on 150 patients undergoing cataract surgery. Pre-operatively the eye was prepared by daubing the peri-ocular skin and a two-minute instillation into the conjunctival fornices. No other antiseptic was applied. Tolerance to the product was evaluated in all the patients: clinical evaluation postoperatively and during a 60-day follow-up period confirmed that the preparation was harmless to the eye. Microbiological investigations (comprising conjunctival swabbing, bacterial culture and count of the bacterial species isolated, before and after application of the product) performed on 60 patients showed a significant fall in the number of colonies after treatment.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Bacteria; Cataract Extraction; Drug Evaluation; Endophthalmitis; Female; Humans; Male; Middle Aged; Povidone-Iodine; Surgical Wound Infection

The authors conducted an open-label nonrandomized parallel trial to examine whether the preoperative application of povidone-iodine to the ocular surface reduces the incidence of endophthalmitis after intraocular surgery. During an 11-month period, topical 5% povidone-iodine was used to prepare the conjunctiva in 1 set of 5 operating rooms, while silver protein solution was used in another set of 5 rooms. In all cases, surgeons continued to use their customary prophylactic antibiotics. A significantly lower incidence of culture-positive endophthalmitis (P less than 0.03) was observed in the operating rooms using povidone-iodine (2 of 3489 or 0.06%) compared with those using silver protein solution (11 of 4594 or 0.24%). Use of topical povidone-iodine in over 3000 cases was not associated with any adverse reactions. In a majority of the observed cases of endophthalmitis, some form of intraoperative communication with the vitreous cavity existed.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Incidence; Male; Middle Aged; New York; Operating Rooms; Postoperative Complications; Povidone-Iodine; Prospective Studies; Silver Proteins

This clinical study was designed to evaluate the difference between preoperative treatment of the conjunctiva with either gentamicin eyedrops or a half-strength povidone iodine solution. We treated 50 eyes of 50 patients who came for cataract surgery and showed bacterial growth in the first conjunctival smear with gentamicin eyedrops at 1-h intervals for at least 10 h. The second smear was taken the next day. At the same time, half strength povidone-iodine solution on was applied to the follow-eye. After 2 min the second smear was taken. With both methods a significant reduction of bacterial growth was achieved. The average number of colonies decreased from 1620 to 63 after treatment with gentamicin and from 1338 to 214 after treatment with povidone iodine. There was no significant difference between the two methods. No allergic reactions or corneal haze after application of povidone iodine were observed.

Topics: Cataract Extraction; Conjunctiva; Endophthalmitis; Gentamicins; Humans; Ophthalmic Solutions; Povidone-Iodine; Premedication; Surgical Wound Infection

Povidone-iodine 5% solution placed on the eye immediately before ophthalmic surgery within the preoperative preparation significantly reduces the conjunctival bacterial flora. In 40 patients undergoing ophthalmic surgery, the authors compared the outpatient use of povidone-iodine for 3 days before surgery with a 3-day course of a combination antibiotic ophthalmic solution (Neosporin) placed on the other eye. All patients also received topical povidone-iodine on the operating table directly preceding surgery. Cultures taken just before preparation of the operative field showed a similar reduction of bacteria by each regimen. Cultures taken after preparation but before commencement of surgery showed a further reduction for both regimens, but more for eyes previously treated with the antibiotic (P less than 0.02). To minimize the conjunctival bacterial flora before surgery, the authors continue to recommend instillation of a broad-spectrum antibiotic for 3 days before surgery, followed by application of povidone-iodine solution to the eye immediately before surgery within the preoperative preparation.

Topics: Ambulatory Care; Bacteria; Clinical Trials as Topic; Endophthalmitis; Eye Diseases; Humans; Ophthalmic Solutions; Povidone; Povidone-Iodine; Preoperative Care; Random Allocation; Surgical Wound Infection

The study analyzes the frequency of acute endophthalmitis occurrence after cataract surgery, the risk factors, characteristic symptoms, and the effectiveness of peri-operative prevention measures.. The study retrospectively analyzed 59 670 cases of patients operated for cataract in 2017-2021. To prevent infections, patients received four instillations of third generation fluoroquinolone (quinolone antibiotic) in the course of two days prior to cataract phacoemulsification (PE), and two instillations immediately (1 hour and 30 minutes) before the surgery; three-minutes treatment of the cornea, conjunctival sac and periocular skin with 5% povidone iodine before the surgery; and as the last step of surgery, patients received subconjunctival injection of 0.05 g cefazolin with 2 mg dexamethasone. Follow-up after surgery included four injections of 0.5% levofloxacin in the course of 7-10 days, and 0.1% dexamethasone for two weeks, or fixed combination of tobramycin and dexamethasone four times per day for two weeks. The criteria for acute endophthalmitis are: loss of spatial vision, absence of red reflex, pronounced thickening of the choroid, suspended particulates in the retrovitreal space and the vitreous observed with ultrasonography in the early postoperative period (day 4-7 after surgery).. Povidone iodine and third generation fluoroquinolone as a method of acute endophthalmitis prevention after cataract surgery demonstrate comparable efficacy to intracameral antibiotic injections.. Анализ частоты возникновения острого эндофтальмита (ОЭ) после хирургии катаракты, факторов риска его развития, наиболее характерных симптомов, а также эффективности применявшихся схем периоперационной профилактики.. Проведен ретроспективный анализ историй болезни 59 670 пациентов, оперированных по поводу катаракты в 2017—2021 гг. Профилактика инфекции включала в себя четырехкратную на протяжении двух предшествующих госпитализации суток, затем двукратную (за 60 и 30 мин до начала вмешательства) инстилляцию фторхинолона третьего поколения, трехминутную обработку периокулярной области и глазной поверхности 5% раствором повидон-йода, завершение факоэмульсификации субконъюнктивальной инъекцией 0,05 г цефазолина и 2 мг дексаметазона с последующими четырехкратными инстилляциями 0,5% раствора левофлоксацина на протяжении 7—10 сут и 0,1% раствора дексаметазона в течение 2 нед либо 14-дневным использованием фиксированной комбинации (ФК) тобрамицина и дексаметазона с частотой инстилляций 4 раза в сутки. Критерии ОЭ — утрата предметного зрения, исчезновение розового рефлекса, выраженное утолщение сосудистой оболочки, мелкоточечная взвесь в ретровитреальном пространстве и стекловидном теле, по данным УЗИ, в раннем (4—7-е сутки) послеоперационном периоде.. Интраоперационное применение повидон-йода и периоперационная терапия фторхинолоном третьего поколения демонстрируют сопоставимую с внутрикамерным введением антибиотика эффективность профилактики ОЭ после хирургии катаракты.

Topics: Anti-Bacterial Agents; Bacillaceae; Cataract; Cataract Extraction; China; Dexamethasone; Endophthalmitis; Estuaries; Eye Infections, Bacterial; Genome, Bacterial; Geologic Sediments; Humans; Levofloxacin; Phylogeny; Postoperative Complications; Povidone-Iodine; Retrospective Studies; Tobramycin

To determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia.. An online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis.. All surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance.. There are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine

The impact of anti-sepsis-anesthesia sequence in intravitreal injection (IVI)-associated endophthalmitis is unknown. We compared outcomes of patients who had 10% topical povidone-iodine before or after 2% topical lidocaine gel during IVIs.. A retrospective study of IVIs in nine clinical sites was undertaken. Group 1 had lidocaine gel applied first. This protocol was changed on March 1, 2020, with Group 2 having povidone-iodine applied first. Visual and micro-biological outcomes were compared.. Among 72 cases (0.07%) from 102,908 IVIs, Group 1 had 59 cases from 65,307 IVI (0.09%) and Group 2 had 13 cases from 37,601 IVI (0.03%;. Application of povidone-iodine before lidocaine gel, compared to after, significantly decreased rate of IVI endophthalmitis, with no significant changes in visual and microbiological outcomes.

Topics: Endophthalmitis; Humans; Incidence; Intravitreal Injections; Lidocaine; Povidone-Iodine; Retrospective Studies

To describe the experience and clinical outcomes of povidone iodine (PI) infusion in the setting of pars plana vitrectomy for the treatment of endophthalmitis.. This was a retrospective case series of 12 patients with clinical and/or culture evidence of endophthalmitis requiring pars plana vitrectomy with 0.025% PI used in vitreous irrigation solution during vitrectomy. The primary endpoint was clinical resolution of the infection. Secondary endpoints included visual recovery, need for repeat surgery, and ocular toxicity RESULTS: There were 11 eyes that showed clinical or culture evidence of resolution of infection postoperatively (91.7%); 10 eyes had improvement in vision postoperatively (83.3%). Overall uncorrected visual acuity improved from 20/5321 (2.43 ± 0.58 logMAR) to 20/375 (1.27 ± 1.05 logMAR) (. PI infusion during pars plana vitrectomy for endophthalmitis appears safe and led to excellent post-surgical results in a traditionally high-risk cohort.

Topics: Endophthalmitis; Humans; Povidone-Iodine; Retrospective Studies; Visual Acuity; Vitrectomy

This study aimed to investigate the efficacy of intravitreal povidone-iodine (PI) administration for the treatment of Candida albicans endophthalmitis. Forty New Zealand white rabbits were divided into four groups (n = 10 per group). After the induction of endophthalmitis using Candida albicans, groups A, B, and C received single intravitreal injections of 0.035 mg voriconazole, 0.3 mg PI, and their combination, respectively. Rabbits that were administered sham injections were in group D as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 7. The anterior chamber flare (grade 0 to 4), severity of iritis (grade 0 to 4), and vitreous opacity (grade 0 to 3) were scored. Candida albicans was cultured in the vitreous sample. On day 7, the vitreous opacities were found in all groups. Compared to that in group D, groups A, B, and C showed a lower score for flare (p < 0.001) and iritis (p < 0.001) and less fungal growth in the vitreous culture (n = 2, 1, 1, and 10 in groups A, B, C, and D, respectively; p < 0.001). Furthermore, ERG and histologic findings demonstrated less affected a- and b-waves and damaged retinal tissues in groups A, B, and C. However, these findings were not different among groups A, B, and C. PI significantly improved Candida albicans endophthalmitis, and the effect was comparable that of the voriconazole, although some vitreous opacities remained. No synergistic effect of the combination of PI and voriconazole was observed. Intravitreal PI may be useful to treat Candida albicans endophthalmitis.

Topics: Animals; Anti-Infective Agents, Local; Candida albicans; Candidiasis; Disease Models, Animal; Endophthalmitis; Eye Infections, Fungal; Female; Intravitreal Injections; Povidone-Iodine; Rabbits

The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema.. Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection.. Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (. Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.

Topics: Aged; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Bacteria; Conjunctiva; Diabetic Retinopathy; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Macular Edema; Male; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies

Our objectives were (1) to report the post-injection endophthalmitis rate over 18 months, and (2) to determine any difference in the incidence of endophthalmitis in patients treated with reduced or no 5% povidone-iodine (PI) due to self-reported PI sensitivity.. We performed a retrospective cohort study of all patients who received intravitreal injections (IVIs) from January 1st, 2018 to June 26th, 2019. Information on patients' age, gender visual acuities, the number of injections, drug administered, self-reported iodine sensitivity and injection protocols were obtained from electronic and paper records. For endophthalmitis cases, vitreous culture results and treatment were also noted. Patients were divided into three cohorts based on the injection protocol used for statistical analysis.. During the study period 22,046 IVIs were administered to 3332 eyes of 2709 patients. Intolerance to PI was reported by 2.4% of patients. The incidence of endophthalmitis was 0.02% (4/21,185) with the standard 5% PI protocol, 0.78% (6/769) with a reduced PI protocol involving fewer drops of 5% PI and chlorohexidine 0.05% for periorbital skin cleansing, and 1.09% (1/92) without any PI use. Receiving the standard PI protocol was associated with significantly lower rates of endophthalmitis compared to both the reduced PI and no PI protocols (p < 0.0001).. Patients who opt for less or no PI use are likely at significantly increased risk of developing post-IVI endophthalmitis. It is imperative to educate, counsel and consent these patients accordingly while exploring alternative antiseptic solutions.

Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Endophthalmitis; Eye Infections, Bacterial; Humans; Incidence; Intravitreal Injections; Iodine; Povidone-Iodine; Retrospective Studies; Self Report

The aim of this study was to investigate the efficacy of intravitreal povidone-iodine (PI) in the treatment of vancomycin-resistant Enterococcus faecalis (VRE) endophthalmitis. Fifty New Zealand white rabbits were divided into 5 groups (n = 10 in each group). After the induction of endophthalmitis using VRE (minimum inhibitory concentration [MIC] ≥ 40 μg/mL) in the right eye, Group A, B, C, and D received intravitreal injections of 0.1% PI, 0.3% PI, 0.05% vancomycin, and 0.5% vancomycin, respectively. Eyes in Group E were used as controls. Fundus photography, vitreous culture, electroretinography (ERG), and histologic examinations of the retina were conducted on day 14. A marked improvement in endophthalmitis was observed in Group A, B, C and D, compared to Group E. Fundus photographs showed mild vitreous opacities in Group A and B, and moderate vitreous opacity in Group C. All eyes in Group D had a clear vitreous. In vitreous culture, bacterial growth was found in 6 eyes (100, 200, 200, 400, 500, and 500 colony-forming units) in Group C, but not in Groups A, B, or D. ERG and histological examination also indicated intraocular damage in Group C. Our results show that intravitreal injection of PI, even at low concentrations, was effective for treatment of VRE endophthalmitis, although some vitreous opacity remained. Intravitreal vancomycin injection was also useful to treat resistant strains, if used at a higher concentration within the safety threshold.

Topics: Animals; Anti-Infective Agents, Local; Colony Count, Microbial; Disease Models, Animal; Electroretinography; Endophthalmitis; Enterococcus faecalis; Eye Infections, Bacterial; Gram-Positive Bacterial Infections; Intravitreal Injections; Povidone-Iodine; Rabbits; Retina; Vancomycin Resistance; Vitreous Body

To verify the possibility that preoperative topical antibiotics are not essential as long as iodine disinfection is performed during surgery.. Crossover equivalence trial.. In 204 eyes of 102 patients who underwent routine bilateral cataract surgery, 1 eye was treated with intraoperative iodine, and the other, with preoperative topical antibiotics. For the intraoperative iodine eyes, 5 mL of 0.25% povidone-iodine was applied at 2 stages: (1) just after the placement of the speculum and (2) before intraocular lens (IOL) insertion. For the contralateral eyes, preoperative topical antibiotics were administered 3 days before surgery without intraoperative iodine. Conjunctival samples for culture were obtained at 3 time points: (a) presurgery, (b) beginning of surgery, and (c) postsurgery. Real-time polymerase chain reaction (PCR) samples were obtained at the beginning of surgery and before IOL insertion. Intracameral moxifloxacin was applied in all the cases.. The respective positive bacterial culture rates for intraoperative iodine eyes and preoperative topical antibiotics eyes were 95.1% and 98.0% at (a), 7.8% and 5.9% at (b), and 60.8% and 62.7% at (c). A significant difference in the positive bacterial culture rate was not found at any time point. For the intraoperative iodine eyes, the bacterial DNA copy number at (b) was significantly lower than that for the preoperative topical antibiotics eyes.. The cleanliness of the operative field without using topical antibiotics was revealed to be equivalent to that of the conventional method (using preoperative antibiotics without intraoperative iodine) as long as intraoperative iodine was used.

Topics: Administration, Ophthalmic; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Conjunctiva; Cross-Over Studies; Disinfection; DNA, Bacterial; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intraoperative Period; Lens Implantation, Intraocular; Levofloxacin; Male; Phacoemulsification; Povidone-Iodine; Real-Time Polymerase Chain Reaction

Dr. Gnanasekaran et al. reported the bactericidal activity of various concentrations of povidone iodine (PI) solution in an agar plate experiment of respiratory flora. The study design and the pharmacokinetic properties of PI solution ensured that dilute PI would not be effective in this study. These results may not replicate the typical clinical situation and are significantly different than a previously reported agar plate experiment, again owing to subtle but very significant differences in methodology.

Topics: Anti-Infective Agents, Local; Bacteria; Colony-Forming Units Assay; Endophthalmitis; Eye Infections, Bacterial; Humans; Povidone-Iodine; Research Design

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Humans; Hypersensitivity; Iodine; Postoperative Complications; Povidone-Iodine; Self Report

The usefulness of povidone-iodine as an alternative to antimicrobial agents, for endophthalmitis, has recently been documented. We report a case of endogenous endophthalmitis successfully treated with intravitreal injection of povidone-iodine.. An 88-year-old woman underwent small bowel bypass surgery for postoperative ileus following rectal cancer resection. She developed a fever during total parenteral nutrition and was diagnosed with gram-positive cocci bacteremia of central venous catheter origin. The patient was referred to our department with chief complaints of ocular pain, hyperemia and decreased vision in the right eye, which had manifested during the febrile period. The initial examination revealed the visual acuity in her right eye to be finger counting and that in her left eye 0.2. The right eye showed a severe inflammatory reaction in the anterior chamber, fibrin deposition, and hypopyon. The fundus was difficult to visualize. Endogenous endophthalmitis due to bacteria was diagnosed. Surgical treatment was judged to be difficult based on the patient's poor general condition and mental status, and intravitreal injection of 0.1 ml of 1.25% povidone-iodine was performed on the same day. The inflammation rapidly diminished, and the hypopyon had disappeared 4 days after treatment. The fundus became visible 7 days after treatment and there was no recurrence of endophthalmitis findings. The visual acuity in her right eye recovered to that in the left eye (0.2).. Intravitreal injection of povidone-iodine is potentially useful and effective as an alternative treatment of antibiotics for endogenous endophthalmitis patients, especially in whom surgical therapy is difficult.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Bacteremia; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Visual Acuity

Clinicians adopt varying strategies for antisepsis with PI, which to this day remains efficient, economical and effective. Clinicians should prudently consider effective PI application, and we thank Koerner and Grzybowski for encouraging debate and raising the profile of this issue.

Topics: Anti-Infective Agents, Local; Endophthalmitis; Humans; Intravitreal Injections; Povidone-Iodine; Speech

To report the rates of postintravitreal injection (IVT) endophthalmitis with topical conjunctival application of various concentrations of povidone-iodine (PI), including no PI.. Retrospective chart review of patients receiving IVTs performed in a single practice between January 2011 and June 2016. Concentration of PI for all injections was recorded and cases of endophthalmitis identified and reviewed.. A total of 35,060 IVTs in 1854 patients were included from the 5.5-year period. 29,281 injections were performed with standard 5% PI, 5,460 injections with diluted PI (3,731 with 2.5%, 1,673 with 1.25%, 56 with 0.625%), and 319 IVTs with no PI. Incidence of patient-reported PI sensitivity occurred in 15.9% of patients. Fourteen cases of endophthalmitis were identified: 12 in eyes that received 5% PI, one in an eye that received 1.25% PI, and one in an eye receiving no PI. The incidence of endophthalmitis was 0.04% for 5% PI, 0.02% for dilute PI, and 0.31% for no PI prophylaxis. All cases underwent prompt vitrectomy and had positive cultures for coagulase-negative Staphylococcus.. Application of dilute PI solution to the conjunctiva at the time of IVT is an effective alternative to 5% PI for endophthalmitis prophylaxis in betadine-sensitive patients.

Topics: Adult; Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Male; Middle Aged; Patient Comfort; Povidone-Iodine; Retrospective Studies

Topics: Endophthalmitis; Humans; Intravitreal Injections; Povidone-Iodine; Ranibizumab

To determine the incidence of endophthalmitis after anti-vascular endothelial growth factor (VEGF) therapy at our institution and to identify potential risk factors for endophthalmitis occurring after injection.. Retrospective, single-center cohort study.. All patients who received an intravitreal injection of an anti-VEGF medication between January 1, 2014, and March 31, 2017.. Current Procedural Terminology and International Classification of Diseases billing codes were used to identify instances of anti-VEGF administration and cases of endophthalmitis. Medical records and injection technique were reviewed carefully in each case. Multivariable logistic regression analysis was performed in a stepwise fashion to determine independent predictors of endophthalmitis based on injection protocol.. Incidence of endophthalmitis after injection and odds of endophthalmitis by injection technique with 95% confidence intervals (CIs).. A total of 154 198 anti-VEGF injections were performed during the period of interest, resulting in 58 cases of endophthalmitis (0.038% [1:2659]). After adjustment for confounders, both 2% lidocaine jelly (odds ratio [OR], 11.28; 95% CI, 3.39-37.46; P < 0.001) and 0.5% Tetravisc (Ocusoft, Richmond, TX; OR, 3.95; 95% CI, 1.15-13.50; P = 0.03) use were independent risk factors for endophthalmitis after injection. Lid speculum use, povidone iodine strength (5% vs. 10%), injection location (superior or inferior), conjunctival displacement, use of provider gloves, use of a strict no-talking policy, use of subconjunctival lidocaine, and topical antibiotic use were not statistically significant predictors of endophthalmitis after injection. There was no difference in endophthalmitis rate among the anti-VEGF agents (bevacizumab, ranibizumab 0.3 mg, ranibizumab 0.5 mg, and aflibercept).. The incidence of endophthalmitis after anti-VEGF injections is low. Use of lidocaine jelly or Tetravisc may increase the risk of endophthalmitis after injection.

Topics: Adult; Angiogenesis Inhibitors; Bevacizumab; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Incidence; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Ranibizumab; Retinal Diseases; Retrospective Studies; Risk Factors; Vascular Endothelial Growth Factor A

Topics: Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Povidone-Iodine; Retina

Topics: Endophthalmitis; Humans; Intravitreal Injections; Povidone-Iodine; Records

Topics: Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Povidone-Iodine; Retina

Topics: Endophthalmitis; Humans; Intravitreal Injections; Povidone-Iodine; Records

We examined the effectiveness and adverse events of using balanced salt solution (BSS) PLUS containing 0.025% povidone-iodine, a non-oculotoxic concentration, for capsular bag irrigation in a case of endophthalmitis mainly involving the anterior chamber. A 57-year-old female underwent cataract surgery and developed hypopyon on day 3 after surgery, with mainly anterior chamber inflammation. The capsular bag was irrigated with BSS PLUS containing 0.025% povidone-iodine. Gram-negative rods were detected from the anterior chamber fluid. Post-procedural visual acuity was 24/20. In a case, endophthalmitis was resolved and there were no adverse events. With the recent increase in multidrug-resistant bacteria, use of 0.025% povidone-iodine in BSS PLUS for anterior chamber irrigation is expected to be useful.

Topics: Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Lens Capsule, Crystalline; Middle Aged; Postoperative Complications; Povidone-Iodine; Treatment Outcome

Topics: Anterior Chamber; Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Humans; Lens Capsule, Crystalline; Povidone-Iodine; Therapeutic Irrigation

Endophthalmitis is one of the most serious complications of cataract surgery. The surgeons try to reduce the incidence of endophthalmitis. In order to prevent postoperative infection, irrigation of the conjunctival sac with povidone iodine and injection of antibiotics into the anterior chamber before the end of the surgery are used. Although there are a lot of reports about the concentration, mode and duration of povidone iodine application, there is no consensus. There are many options for antibiotics, including cefuroxime, vancomycin and moxifloxacin. Side effects of using povidone iodine and antibiotics have also been reported. An aseptic surgical mask plays an important role in isolating bacteria for prevention of infection. However, whether it could completely isolate bacteria can not be determined. In this article, several issues concerning the prevention of infection after cataract surgery are discussed. We hope that there will be a multi-center and large-sample research to assist in drawing up operating specifications.. 感染性眼内炎是白内障摘除手术最严重的并发症之一，如何减少白内障摘除术后感染性眼内炎的发生备受关注。目前临床常采用聚维酮碘结膜囊灌洗、手术末前房注射抗生素等方法预防术后感染。聚维酮碘的应用浓度、方式以及作用时间国内外尚无统一意见，用于前房注射的抗生素也有很多选择，各种方法均存在不良反应。无菌手术贴膜在术中隔离菌群、预防感染方面发挥了重要的作用，但效果尚无法确定。本文就白内障摘除术后预防感染中值得关注的问题进行分析讨论，以期为开展多中心、大样本研究提供参考，制定相应的操作规范。

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine

To investigate the safety of intracameral injection of minimum bactericidal concentration (MBC) of povidone iodine (PI) on the corneal endothelium in a rabbit model as a proposed method of prophylaxis against postoperative endophthalmitis.. We included 32 New Zealand white rabbits in the study. Twenty-four rabbits received intracameral injections of 0.1 mL of 0.25% PI, and they were sequentially killed at intervals; first, seventh, and 14th day. The control group included 4 rabbits that received intracameral injections of 0.1 mL normal saline, and 4 rabbits that underwent the same intraocular procedure without injections (sham operated). Slit-lamp examination and ultrasonic corneal pachymetry were performed before and after injections for both eyes. The corneas were histopathologically examined by light and electron microscopy.. MBC of PI (0.25%) was toxic to rabbits' corneal endothelium as evident by histopathological changes, corneal edema, and increased corneal thickness on day 1. Signs of healing were obvious on day 7 and were almost complete on day 14, as detected by histopathology, subsidence of corneal edema, and normalization of corneal thickness.. MBC (0.25%) of PI was found toxic to the rabbits' corneal endothelium, with progressive regeneration and complete healing within 2 weeks. To our knowledge, we are the first to use MBC of PI in intracameral injection trials. Further studies on primates, which have more comparable regenerative capacity to humans' corneal endothelium, are encouraged to evaluate their endothelial healing response.

Topics: Animals; Anterior Chamber; Anti-Infective Agents, Local; Disease Models, Animal; Dose-Response Relationship, Drug; Endophthalmitis; Endothelium, Corneal; Eye Infections, Bacterial; Injections, Intraocular; Povidone-Iodine; Rabbits

To evaluate the bacterial flora of corneal wounds at the end of cataract surgery before intracameral antibiotic use and to determine agents to treat postoperative endophthalmitis, the potential for biofilm formation, and antibiotic resistance.. This cross-sectional clinical study included patients who underwent cataract surgery using the phacoemulsification technique without any complications. The hemifacial skin, periocular area, eyelids and eyelashes were washed with 10% povidone-iodine and the conjunctiva was washed with 5% povidoneiodine before cataract surgery. After uncomplicated surgery, a wipe sample was taken from the bulbar conjunctival surface, corneal surface, and wound rim before administering intracameral antibiotics. All samples were plated on blood agar, MRS agar, M17 agar, calcium-lactate agar, plate-count agar, and Sabouraud-dextrose agar. Biofilm formation was evaluated by microtitre plates and the Congo red-agar method. Antimicrobial resistance patterns of isolates were determined by the agar-disk diffusion method.. We recruited 50 patients and studied 55 eyes, obtaining 34 isolates from the cultures of 16 eyes. Isolated organisms were coagulase-negative staphylococci (CoNS) (35.3%), Bacillus cereus (29.4%) and Pseudomonas spp. (5.9%). We obtained isolates from 64% of diabetic cases and 20% of non-diabetic cases, (p=0.002). It was observed that 21 out of 34 isolates produced a weakly positive biofilm, 8 were moderately positive, three were strongly positive, and two isolates were biofilm negative. Of the CoNS strains four of the 11 were resistance to four or more antibiotics.. Microorganisms that remained at the end of cataract surgery had the capacity to produce biofilm and had high antibiotic resistance. Appropriate preoperative disinfection is very important and adequate disinfection and suitable antibiotics should be kept in mind for avoiding endophthalmitis, especially for diabetic patients. Biofilm is one of the major factors affecting the virulence of bacteria, and further studies into prevention of biofilm formation are required in this area.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Biofilms; Cataract Extraction; Cross-Sectional Studies; Disinfectants; Drug Resistance, Microbial; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Phacoemulsification; Postoperative Complications; Povidone-Iodine; Visual Acuity

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Antisepsis; Chlorhexidine; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Povidone-Iodine

To present cases of endophthalmitis following intravitreal injections where povidone-iodine (PI) was not used as part of the surgical preparation.. Retrospective case series.. All cases of presumed injection-related endophthalmitis presenting to the Massachusetts Eye and Ear Infirmary between June 2008 and November 2014 and Dean McGee Eye Institute between January 2010 and January 2015 were identified. Patients who did not receive PI preparation owing to documented self-reported allergy to iodine, iodine-containing contrast material, or shellfish were identified and their injection histories and clinical courses reviewed.. The combined rate of postinjection endophthalmitis at these 2 centers was 0.019%. Among 42 patients with postinjection endophthalmitis, 5 (11.9%) did not receive PI prophylaxis. The mean number of intravitreal injections without PI before the development of endophthalmitis was 10.6 with a 9.4% rate of endophthalmitis (5 cases per 53 injections). All patients underwent tap-and-inject procedures with vancomycin 1 mg and ceftazidime 2 mg. Two patients did not receive PI at the time of tap and inject; 1 of these patients required subsequent pars plana vitrectomy for worsening clinical course. Cultures were positive in 4 of 5 cases; all positive cultures grew coagulase-negative Staphylococcus. All patients who received subsequent intravitreal injections received PI prophylaxis without allergic reactions, thus demonstrating a lack of true PI allergy.. Avoiding PI owing to self-reported iodine "allergy" risks substantial ocular morbidity. Allergy testing can be pursued per patient request or in rare cases of suspected true PI allergy; however, in cases where delayed treatment would adversely affect visual outcome, the clinician should feel confident that minimal allergic risk exists.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Bacterial Agents; Drug Hypersensitivity; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Middle Aged; Povidone-Iodine; Retrospective Studies; Self Report; Staphylococcal Infections; Staphylococcus; Vascular Endothelial Growth Factor A

To correlate the incidence of postoperative endophthalmitis with changes in the preoperative prophylaxis over a 20-year period.. Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.. Retrospective chart review.. Patients diagnosed with postoperative endophthalmitis from 1990 to 2009 after intraocular surgery performed at the same institution were included. Because of changes in the preoperative prophylaxis during the study period, 3 groups were formed for data analysis: Period 1 (1990 to 1992), no standardized prophylaxis regimen; period 2 (1993 to 1998), preoperative topical medication, povidone-iodine 10.0% periorbitally, and 1 drop of povidone-iodine 1.0% in the conjunctiva sac; and period 3 (1999 to 2009), similar to period 2 except with irrigation of the conjunctival sac with 10 mL of povidone-iodine 1.0%.. The overall rate of postoperative endophthalmitis was 0.113% (77/68,323) for all intraocular surgeries. It decreased significantly from 0.291% (16/5505) in period 1 to 0.170% (33/19,413) in period 2 to 0.065% (28/43,405) in period 3 (P < .001). In cataract surgery, the overall rate of postoperative endophthalmitis was 0.125% (30/24,034). It decreased in each subsequent period, from 0.338% (9/2662) in period 1 to 0.224% (15/6696) in period 2 to 0.041% (6/14,676) in period 3 (P < .001). Coagulase-negative Staphylococcus was the most commonly isolated organism (47.4%).. The rate of postoperative endophthalmitis decreased over a 20-year period at a single academic institution. Although multiple factors might have contributed to this decline, implementation of a preoperative prophylaxis protocol using copious povidone-iodine might have been the most important contributor.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anterior Chamber; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteria; Cataract Extraction; Child; Child, Preschool; Endophthalmitis; Eye Infections; Female; Fungi; Humans; Incidence; Infant; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Pre-Exposure Prophylaxis; Retrospective Studies

Topics: Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections; Female; Humans; Male; Postoperative Complications; Povidone-Iodine; Pre-Exposure Prophylaxis

Topics: Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections; Female; Humans; Male; Postoperative Complications; Povidone-Iodine; Pre-Exposure Prophylaxis

Topics: Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections; Female; Humans; Male; Postoperative Complications; Povidone-Iodine; Pre-Exposure Prophylaxis

Topics: Anti-Infective Agents, Local; Cataract Extraction; Endophthalmitis; Eye Infections; Female; Humans; Male; Postoperative Complications; Povidone-Iodine; Pre-Exposure Prophylaxis

To investigate the bactericidal effect of 0.025% povidone-iodine in Balanced Salt Solution PLUS (0.025% PI-BSS PLUS) and its use in vitrectomy for postoperative endophthalmitis.. First, an experimental laboratory model using Staphylococcus aureus was used to evaluate the bactericidal effect of PI-BSS PLUS. Next, in a case series of 4 eyes with postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS as irrigation solution was conducted, followed by postoperative intravitreal and intravenous antibiotics.. In in vitro study, PI at concentrations of 0.01% and above in BSS PLUS exhibited marked bactericidal effect after 15 seconds of exposure. Bactericidal effect of 0.025% PI-BSS PLUS was maintained at room temperature storage for 15 minutes but was attenuated after 30 minutes. Among 4 eyes that underwent vitrectomy using 0.025% PI-BSS PLUS, coagulase-negative Staphylococcus sp. was isolated in 1 eye at the beginning but not at completion of surgery. In all four eyes, endophthalmitis was resolved with no adverse events. Ocular toxicity was not observed.. The 0.025% PI-BSS PLUS is bactericidal and nontoxic when used as irrigation solution in vitrectomy. In 4 cases of postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS followed by postoperative antibiotics resolved endophthalmitis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bicarbonates; Colony Count, Microbial; Combined Modality Therapy; Drug Combinations; Endophthalmitis; Eye Infections, Bacterial; Female; Glutathione; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Therapeutic Irrigation; Vitrectomy

The purpose of this study was to investigate the pharmacokinetics and safety of intravitreal povidone-iodine (PVI) and its efficacy against experimental Staphylococcus epidermidis endophthalmitis.. In phase I, forty New Zealand white rabbits were divided into groups I and II and received intravitreal 0.1% and 0.3% PVI, respectively. Electroretinography (ERG) and histologic examinations were conducted at baseline, 6, and 12 hours. Half-life was determined using high-performance liquid chromatography. In phase II, after the induction of S. epidermidis endophthalmitis, 0.1% and 0.3% PVI were injected intravitreally once in groups A and B and three times every second day in groups C and D (n = 10 in each group). Electroretinographs, histologic examinations, and vitreous cultures were conducted on day 14.. Electroretinography and histologic examinations did not reveal any notable retinal damage in phase I in either group. Half-lives were 3.27 and 3.58 hours in groups I and II, respectively. In phase II, all groups demonstrated marked improvement, compared to controls. Bacterial growth was found in four eyes in group A (20, 60, 60, and 70 colony forming units [CFU]) and in three eyes in group B (20, 40, and 60 CFU) but not in those belonging to groups C and D at day 14. Retinal damage with lymphocyte infiltration in the inner retinal layers was more common in groups A and B than in groups C and D.. Half-life of PVI was approximately 3 hours in the vitreous. Repeated injection of intraocular PVI, even at low concentrations, is most likely to be effective for the treatment of bacterial endophthalmitis.

Topics: Animals; Anti-Bacterial Agents; Electroretinography; Endophthalmitis; Eye Infections, Bacterial; Half-Life; Intravitreal Injections; Povidone-Iodine; Rabbits; Retina; Staphylococcal Infections; Staphylococcus epidermidis; Vitreous Body

To report the incidence, clinical features, microbiologic culture results, management and visual outcome of patients with endophthalmitis after intravitreal injections (IVTs).. This retrospective chart review included all patients receiving IVTs between January 2005 and July 2012. Cases of suspected and confirmed endophthalmitis after IVT were identified and reviewed.. A total of 20,179 IVTs were perfomed during the study period. Six cases of supected endophthalmitis were identified clinically (0.03%), of which 3 were culture positive (0.015%). The risk of culture-positive post-IVT endophthalmitis was 2/8,882 (0.023%) in the 2005 to 2008 period and 1/11,297 (0.009%) in the period 2009 to 2012. Symptoms developed within the first 3 days after IVT in 4 of the 6 patients and visual acuity was reduced to hand motion in 4 of the 6 patients. Microbiologic specimens were positive on 3 of the 6 cases (coagulase-negative Staphylococcus, n = 2; Staphylococcus aureus, n = 1). Mean visual acuity before patients with endophthalmitis was 20/100, whereas mean final visual acuity at last follow-up was 20/200.. The incidence of endophthalmitis after IVT was low with no cases because of Streptococcus species in the present setting using povidone-iodine in the preoperative disinfection of the conjunctival sac. Therefore, adherence to standardized protocols including the use of povidone-iodine when performing IVTs is recommended.

Topics: Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Female; Germany; Humans; Incidence; Intravitreal Injections; Male; Middle Aged; Povidone-Iodine; Referral and Consultation; Retinal Diseases; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Tertiary Care Centers; Visual Acuity

Intravitreal injection has become a common procedure worldwide. A rare, but sight threatening, complication is bacterial endophthalmitis that has a poor visual prognosis. To identify practices that minimize the risk of endophthalmitis, the setting of a Danish University hospital is described.. A review of the intravitreal injection database of the department. All injections were performed in a positive pressure ventilated operating room under sterile conditions. The treating physicians wore face mask, the conjunctiva was irrigated twice with 5% povidone-iodine preoperatively, and topical tobramycin was applied immediately after the injection.. The authors have performed a total of 20,293 injections were performed in 2,575 eyes. No cases of proven or suspected endophthalmitis were identified corresponding to a risk of 0% (95% confidence interval, 0-0.019) per injection and 0% (95% confidence interval, 0-0.15%) per patient. Approximately 7,000 injections, all in patients without diabetes, were treated without a course of topical antibiotics after the injection.. The department has had the lowest rate of endophthalmitis after intravitreal injections in the current literature. Several factors that could have contributed to the positive result are highlighted. Omitting a postoperative course of topical antibiotic appears safe in patients without diabetes.

Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Anti-Infective Agents, Local; Denmark; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Operating Rooms; Povidone-Iodine; Practice Patterns, Physicians'; Respiratory Protective Devices; Retinal Diseases; Tobramycin; Vascular Endothelial Growth Factor A

To report conjunctival bacterial flora antibiotic resistance patterns after serial intravitreal injections performed using a povidone-iodine preparation without the use of preinjection or postinjection topical antibiotics.. Prospective, interventional case series.. Single-center clinical practice in Pennsylvania.. Thirteen eyes of 13 treatment-naïve patients undergoing serial intravitreal anti-vascular endothelial growth factor (VEGF) injections for exudative age-related macular degeneration or macular edema attributable to retinal vein occlusion.. Conjunctival cultures from the treatment eye were performed prior to each injection preparation. A minimum of 3 monthly conjunctival cultures were obtained per eye over the course of the study. Ocular surface preparation consisted of topical anesthetic and povidone-iodine 5% without the use of preinjection or postinjection topical antibiotics.. Conjunctival flora growth patterns and antibiotic resistance patterns to several common antibiotics tested over the course of the study.. A total of 48 cultures were performed with a 77% culture positivity rate. Over the course of the serial conjunctival cultures in each patient, there was no evidence for emergence of resistant bacteria to any of the tested antibiotics (including fluoroquinolones and azithromycin) or significant alteration from baseline conjunctival flora. Of the 47 bacterial isolates, the most commonly isolated organism was coagulase-negative Staphylococcus both at baseline (73%) and following serial intravitreal injections (78%, P = .73).. Ocular surface preparation for intravitreal injection using povidone-iodine 5% alone in the absence of postinjection topical antibiotics does not appear to promote bacterial resistance or a discernible change in conjunctival flora.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteria; Conjunctiva; Drug Resistance, Bacterial; Endophthalmitis; Female; Humans; Intravitreal Injections; Macular Edema; Male; Microbial Sensitivity Tests; Middle Aged; Povidone-Iodine; Prospective Studies; Vascular Endothelial Growth Factor A; Wet Macular Degeneration

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Postoperative Complications; Povidone-Iodine; Vitrectomy

To investigate the contamination rates in patients undergoing strabismus surgery who received a single versus a dual application of povidone-iodine.. Patients undergoing strabismus surgery were divided into two groups of approximately equal size. Prior to surgery, the surgical sites for both groups were prepared by applying 4 drops of povidone-iodine 5% directly into the conjunctival fornices, after which the eyelashes were cleaned with cotton tips soaked with povidone-iodine 5%. Sterile gauze pads soaked with povidone-iodine 5% were used to clean the periocular skin. After lid speculum placement, the patients in the dual application group received an additional 2 drops of povidone-iodine in the conjunctival fornices. Intraoperatively, the conjunctiva, sclera, needles/sutures, and lid speculum were cultured. Gram stain and cultures were obtained and quantified. Contamination was defined as any bacterial growth on blood agar plates at 2 days.. A total of 104 patients (aged 7 months to 79 years) were included. The single application group had a 25% contamination rate of surgical site and sutures; the dual application group, a 10% contamination rate. This difference was statistically significant (P = 0.03). The rate of eyelid speculum contamination was unaffected by additional applications (12.5% contamination rate in both groups [P = 0.5]). The additional application of povidone-iodine affected the contamination rate of the conjunctival incision site the most, with a decrease from 20.5% to 5% (P = 0.02).. In our study cohort a second application of povidone-iodine significantly decreased the rate of contamination of the surgical site and sutures. It did not affect contamination of the lid speculum.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacteria; Child; Child, Preschool; Colony Count, Microbial; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Infant; Male; Middle Aged; Oculomotor Muscles; Povidone-Iodine; Strabismus; Surgical Wound Infection

Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Conjunctiva; Drug Contamination; Endophthalmitis; Eye Infections, Bacterial; Eyelids; Humans; Intravitreal Injections; Ophthalmic Solutions; Povidone-Iodine; Risk Factors; Vitreous Body

Topics: Administration, Topical; Angiogenesis Inhibitors; Anti-Bacterial Agents; Endophthalmitis; Humans; Intravitreal Injections; Ophthalmic Solutions; Povidone-Iodine; Standard of Care; Vascular Endothelial Growth Factor A; Vitreous Body

To evaluate the efficacy of a prophylactic regimen of daily topical 0.5% moxifloxacin and 5% povidone-iodine (PI) in patients with Boston type I keratoprosthesis (KPro) and to assess the applicability of a novel molecular diagnostic technique to analyze the ocular surface microbiota in these patients.. Ten patients had their inferior conjunctival fornix sampled for standard culture methods before the addition of topical 5% PI to the prophylactic regimen and were considered the control group (group 1). The inferior conjunctival fornix and the KPro-donor cornea interface of 10 patients treated with the mentioned prophylactic regimen were sampled and analyzed by standard culture methods and using a polymerase chain reaction/electrospray ionization mass spectrometry assay (group 2).. Samples from the inferior conjunctival fornix were positive for coagulase-negative staphylococcus in 3 patients and for Aerobasidium pullulans in 1 patient in group 1. The inferior conjunctival fornix and the KPro-donor cornea interface scrapings were positive for coagulase-negative staphylococcus in 2 patients and 1 patient, respectively, in group 2. No bacteria and fungi growth were detected in any patient from group 2 with the molecular diagnostic approach. None of the patients with culture-positive results developed keratitis or endophthalmitis during the study.. Topical 0.5% moxifloxacin associated with topical 5% PI is an effective prophylactic regimen in patients with Boston type I KPro. The molecular diagnostic approach using serial polymerase chain reaction and mass spectrometry was comparable with standard microbiologic techniques as a surveillance tool in these patients.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Aza Compounds; Corneal Diseases; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Fluoroquinolones; Gram-Positive Bacterial Infections; Humans; Male; Molecular Diagnostic Techniques; Moxifloxacin; Povidone-Iodine; Prospective Studies; Prostheses and Implants; Quinolines; Staphylococcus aureus

To examine the bacterial detection rate in infusion fluid collected inside the fluid catch bag during 25-gauge (25G) vitrectomy when the ocular surface was irrigated with infusion fluid or 0.25 % povidone-iodine. Two groups using different fluids for ocular surface irrigation during 25G vitrectomy were studied. Fifty-five consecutive eyes received ocular surface irrigation with infusion fluid (IF group) and 52 consecutive eyes with 0.25 % povidone-iodine (PI group). Samples of ocular surface fluid were collected at the beginning of surgery and samples of infusion fluid inside the fluid catch bag were collected at the end of surgery for bacteriological cultures. At the beginning of surgery, the bacterial detection rates in ocular surface fluid samples were 5.8 % (3 of 52 eyes) in the IF group and 7.7 % (4 of 52 eyes) in the PI group, with no significant difference (P = 0.6955). At the end of surgery, the bacterial detection rates in infusion fluid collected inside the fluid catch bag were 23.1 % (12 of 52 eyes) in the IF group and 3.8 % (2 of 52 eyes) in the PI group, with a significant difference (P = 0.0041). No endophthalmitis occurred in either group. These results demonstrate the risk of bacterial contamination when surgical instruments fall accidentally into the fluid catch bag during conventional 25G vitrectomy. Irrigating the ocular surface with 0.25 % povidone-iodine instead of infusion fluid significantly reduces the bacterial contamination rate in the fluid catch bag.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bacteria; Body Fluids; Conjunctiva; Disinfection; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Povidone-Iodine; Retrospective Studies; Surgical Wound Infection; Therapeutic Irrigation; Vitrectomy

To examine whether repeated ocular surface irrigation with 0.25% povidone-iodine, which is highly bactericidal and nonoculotoxic, reduces bacterial contamination of the vitreous during 25-gauge vitrectomy.. Overall, 4,407 eyes undergoing 25-gauge vitrectomy were studied; of these, 2,801 were irrigated with infusion fluid (group A) and 1,606 with 0.25% povidone-iodine (group B). In each group (A and B), 103 eyes were studied bacteriologically, using ocular surface fluid samples after placing lid speculum (S1), after operative field irrigation (S2), and in vitreous samples at the beginning (V1) and at the completion of vitrectomy (V2).. Bacterial contamination rate in S1 did not differ significantly between the groups A (5.5%) and B (6.8%). However, the contamination rates in S2, V1, and V2 were apparently lower in group B (0%, 0%, and 0%, respectively) than in group A (2.0%, 1.0%, and 2.0%, respectively). Incidence of endophthalmitis was 0 of 2,801 eyes in group A and 0 of 1,606 eyes in group B.. In 25-gauge vitrectomy, repeated operative field irrigation with 0.25% povidone-iodine reduced bacterial contamination in vitreous to extremely low level.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bacteria; Child; Endophthalmitis; Eye; Eye Infections, Bacterial; Humans; Middle Aged; Povidone-Iodine; Therapeutic Irrigation; Vitrectomy; Vitreous Body; Young Adult

To examine the efficacy of complying with an infection control manual for intravitreal injection of anti-vascular endothelial growth factor (VEGF) preparations in reducing the rate of endophthalmitis.. We retrospectively reviewed intravitreal anti-VEGF injections conducted by vitreoretinal specialists at the outpatient injection room of a single university hospital between July 2009 and July 2012. The injections were conducted following an infection control manual established by our department. Doctors and nurses wore surgical masks, and disinfected the patient's eyelid skin with 10% povidone-iodine and then the conjunctiva with 0.25% povidone-iodine. After putting a drape on the patient's face, a lid speculum was placed. The conjunctival surface was again washed with 5 ml of 0.25% povidone-iodine. After waiting at least 30 seconds, intravitreal injection was performed through povidone-iodine. Following injection, the injection site was again washed with 5 ml of 0.25% povidone-iodine. Patients were treated with topical levofloxacin 4 times a day for 3 days before and after the injection.. A total of 15,144 injections comprising 548 injections of pegaptanib sodium, 846 injections of bevacizumab, and 13,750 injections of ranibizumab were performed. During this period, no case of suspected or proven infectious endophthalmitis occurred. The endophthalmitis rate was 0 per 15,144 injections, (95% confidence interval, 0.0-0.0%).. The results suggest that endophthalmitis can be reduced to a minimum by preventing normal flora of the conjunctiva and bacteria in the oral cavity from entering the vitreous. For this purpose, an infection control manual that requires nurses and doctors to wear surgical mask and drape the patient's face, irrigate the conjunctiva with 0.25% povidone-iodine and wait at least 30 seconds before performing intravitreal injection is useful.

Topics: Angiogenesis Inhibitors; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Monoclonal, Humanized; Aptamers, Nucleotide; Bevacizumab; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Levofloxacin; Masks; Povidone-Iodine; Ranibizumab; Retrospective Studies; Therapeutic Irrigation; Vascular Endothelial Growth Factor A

To determine the in vitro susceptibility of post-cataract surgery endophthalmitis bacterial isolates to different concentrations of povidone-iodine at different exposure times.. Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.. Experimental study.. Ocular-fluid samples obtained from patients diagnosed with postoperative endophthalmitis were submitted to a microbiology laboratory for culture. One milliliter of microbial isolate suspension with a McFarland standard turbidity of 0.5 was mixed with 1 mL of 1%, 2%, 5%, and 10% povidone-iodine solutions. After 1 minute, 5 minutes, and 15 minutes of exposure at 37°C, each solution was transferred to appropriate culture media and incubated at 37°C for 24 hours.. Organisms were isolated in 30 (68%) of the 44 patients evaluated. Coagulase-negative Staphylococcus was identified in 14 cases (47%), Streptococcus species in 8 cases (27%), Staphylococcus aureus in 5 cases (17%), Bacillus cereus in 2 cases (6%), and Pseudomonas aeruginosa in 1 case (3%). Higher povidone-iodine concentrations and longer exposure times were more effective than lower povidone-iodine concentrations or shorter exposure in preventing growth of bacterial isolates. The most effective regimens were 5% povidone-iodine for 15 minutes and 10% povidone-iodine for at least 5 minutes. With a high bacterial load, 13% of bacterial isolates remain viable after exposure to 10% povidone-iodine, even with a long exposure time.. Results indicate that using 5% povidone-iodine for 15 minutes or 10% povidone-iodine for 5 minutes can prevent the growth of most post-cataract surgery endophthalmitis bacterial isolates.

Topics: Anti-Infective Agents, Local; Aqueous Humor; Bacteria; Bacteriological Techniques; Colony Count, Microbial; Endophthalmitis; Eye Infections, Bacterial; Humans; Microbial Sensitivity Tests; Microbial Viability; Phacoemulsification; Postoperative Complications; Povidone-Iodine; Time Factors; Vitreous Body

To provide experimental evidence to support or refute the proposition that the use of surgical face masks and/or avoidance of talking can decrease the dispersion of respiratory flora during an intravitreal injection.. Ten surgeons recited a 30-second standardized script with blood agar plates positioned 30 cm below their mouths. The plates were divided into 4 groups, with 10 plates per group. In Group 1, participants did not wear a face mask. In Group 2, participants wore a standard surgical mask. In Group 3, no mask was worn, but plates were pretreated with 5% povidone-iodine. In Group 4, no mask was worn, and participants remained silent for 30 seconds. The plates were then incubated at 37°C for 24 hours, and the number of colony-forming units (CFUs) was determined.. Mean bacterial growth were as follows: Group 1, 8.6 CFUs per subject; Group 2, 1.1 CFUs per subject; Group 3, 0.1 CFUs per subject; and Group 4, 2.4 CFUs per subject. Differences between the groups were statistically significant (P < 0.05), with the exception of Group 2 versus Group 4 (P = 0.115).. The use of a face mask and avoidance of talking each significantly decreased the dispersion of bacteria. Even without these interventions, plates pretreated with povidone-iodine demonstrated the least bacterial growth.

Topics: Anti-Infective Agents, Local; Bacteria; Colony Count, Microbial; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Masks; Povidone-Iodine; Respiratory System; Verbal Behavior

Topics: Administration, Topical; Angiogenesis Inhibitors; Anti-Infective Agents, Local; Antibodies, Monoclonal, Humanized; Bevacizumab; Endophthalmitis; Eye Infections, Bacterial; Humans; Intravitreal Injections; Povidone-Iodine; Ranibizumab; Risk Factors; Triamcinolone Acetonide; Vascular Endothelial Growth Factor A

Topics: Anterior Chamber; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Cefuroxime; Endophthalmitis; Eye Infections, Bacterial; Humans; Incidence; Povidone-Iodine; South Africa; Surveys and Questionnaires

To determine the incidence of bacterial contamination of needles used for intravitreal injections.. Patients undergoing intravitreal injections were enrolled prospectively. No pre-injection antibiotics were administered. Following povidone-iodine irrigation, conjunctival cultures were taken and the injection was performed. The needle was cultured. A dry control needle was exposed to the surgical field and cultured.. No patients developed endophthalmitis. Eighteen injection needles (18%) yielded positive bacterial growth. The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n = 6). Four control needles showed positive growth, in 2 cases with the same organism as a matching positive used needle. The difference between contamination rates of used and control needles was significant (p = .002, McNemar's test).. Bacterial contaminants are present on a substantial proportion of needles. Since the needle contacts both the ocular surface and the vitreous, it is possible that inoculation of the vitreous cavity occurs in such cases.

Topics: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bevacizumab; Choroidal Neovascularization; Cross-Sectional Studies; Diabetic Retinopathy; Endophthalmitis; Equipment Contamination; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Macular Degeneration; Male; Middle Aged; Needles; Povidone-Iodine; Propionibacterium acnes; Prospective Studies; Ranibizumab; Staphylococcus epidermidis; Vitreous Body

We report the endophthalmitis rate after cataract surgery in patients preoperatively given topical povidone-iodine and gentamicin-containing irrigation fluid as prophylaxis without intracameral cefuroxime or perioperative topical antibiotics. In a retrospective clinical study, we included patients undergoing cataract surgery over a 12-year period at one large university teaching hospital. Data from 26,566 cataract procedures were analysed. Cases of postoperative endophthalmitis were identified and diagnosed both clinically and microbiologically. A total of 26,566 cataract procedures were reviewed, and we identified 16 patients with postoperative endophthalmitis (rate: 0.6 per 1000 operations, or 0.06%; 95% confidence interval: 0.03-0.09%). A causative micro-organism was detected in 81.3% (13/16) of the cases. Most organisms were Gram-positive bacteria (10/13) with susceptibility to cefuroxime (9/10) and/or fluoroquinolones (4/8), and/or resistance to aminoglycosides (10/10). The three Gram-negative pathogens were susceptible to cefuroxime, aminoglycosides, and fluoroquinolones. Using our regimen of topical povidone-iodine and gentamicin irrigation, we observed a low postoperative endophthalmitis rate not differing from the infection rates recently reported in other large studies. We speculate that neither intracameral cefuroxime nor perioperative levofloxacin eye drops are necessary to minimise postoperative infectious complications following cataract surgery, and we suggest that the European Society of Cataract and Refractive Surgery guidelines (in which perioperative antibiotics are mandatory) therefore be revisited to permit alternative effective regimens for the prevention of postoperative infections following cataract surgery.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Endophthalmitis; Eye Infections, Bacterial; Female; Gentamicins; Germany; Hospitals, University; Humans; Male; Middle Aged; Perioperative Care; Postoperative Complications; Povidone-Iodine; Practice Guidelines as Topic; Treatment Outcome

Topics: Anti-Bacterial Agents; Antisepsis; Chlorhexidine; Drug Costs; Endophthalmitis; Humans; Intravitreal Injections; Ophthalmic Solutions; Povidone-Iodine

Topics: Administration, Topical; Anesthetics, Local; Anti-Infective Agents; Bacteria; Colony Count, Microbial; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Fluoroquinolones; Gatifloxacin; Humans; Injections; Lidocaine; Ophthalmic Solutions; Povidone-Iodine; Single-Blind Method; Vitreous Body

The aim of the current study is to evaluate the role of povidone iodine (PVI) in the management of experimental bacterial endophthalmitis in young rabbits.. Twenty white rabbits were used. Colony-forming units (CFU) of Staphylococcus epidermidis were injected intravitreally into the right eye of each animal. Injected eyes were evaluated clinically daily (anterior and posterior segment examination), and when clinical signs of endophthalmitis appeared, an injection of 0.1 ml PVI was made intravitreally. In group 1 (n = 10), the injected concentration of PVI was 0.1%, and in group 2 (n = 10) the concentration was 0.2%. At the end of the observation period, vitreous sample culture was made, and vitreous and retina specimens were taken for light histology examination as well. results: Group 1 eyes did not show any signs of clinical improvement. Vitreous culture showed the presence of 10(8) CFU/ml of S. epidermidis. Histological examination indicated acute inflammation. Group 2 animals presented a clear gradual regression of the inflammation. Vitreous culture for S. epidermidis proved to be sterile. Histological examination indicated chronic inflammation.. Intravitreal injection of 0.2% PVI is likely to inhibit bacterial endophthalmitis of rabbit eyes due to S. epidermidis.

Topics: Animals; Anti-Infective Agents, Local; Aqueous Humor; Colony Count, Microbial; Endophthalmitis; Eye; Inflammation; Povidone-Iodine; Rabbits; Staphylococcal Infections; Staphylococcus epidermidis; Treatment Outcome

To evaluate potential sources of bacterial contamination during intravitreal (IVT) injection procedures.. Patients scheduled for IVT injection were asked to enroll in the study at the California Vitreoretinal Center (Menlo Park, CA) and the Vantage Eye Center (Salinas, CA) between October 2004 and April 2005. A total of 104 patients participated in the study, with a total of 118 IVT injection procedures performed on 107 eyes. Standard microbiological techniques were used to culture, identify, and quantify bacterial contamination of injection needles and the bulbar conjunctiva at the injection site in patients undergoing IVT injections. The main outcomes measured were type and quantity of bacterial isolates.. Two (2%) of 114 needles collected were contaminated with bacteria. The prevalence of bacterial contamination of the injection site on the bulbar conjunctiva was 43% before prophylaxis on the day of the injection with topical antibiotics and povidone-iodine, with a statistically significant reduction to 13% after prophylaxis (P < 0.0001). Coagulase-negative Staphylococcus, the most common bacterium isolated from the ocular surface, was isolated from both culture-positive needles.. IVT injection needles became contaminated with bacteria during the injection procedure. Although the contamination rate was low, this supports a mechanism of postinjection endophthalmitis in which there is direct inoculation of ocular surface flora into the vitreous cavity by the injection needle.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Bacteriological Techniques; Conjunctiva; Endophthalmitis; Equipment Contamination; Female; Humans; Injections; Male; Middle Aged; Needles; Povidone-Iodine; Vitreous Body

To compare the incidence of postoperative endophthalmitis in clear corneal cataract surgeries performed with and without suture closure, antibiotics and povidone iodine.. Ambulatory surgery facility.. In a retrospective, consecutive case-series study, we reviewed the incidence of endophthalmitis in 815 consecutive eyes that underwent cataract surgery by a single surgeon over a 5-year period (379 unsutured and 436 sutured, 294 without and 521 with antibiotic drops in the immediate postoperative period, and 247 without and 568 with povidone iodine before patching).. There were five cases of culture-positive postoperative endophthalmitis in the unsutured group and none in the sutured group (p = 0.022). Although patients in these two groups received routine preoperative antibiotic and povidone-iodine drops, those in whom antibiotic eye drops were not initiated until the day after surgery (p = 0.006) and those who did not receive 5% povidone-iodine drops immediately after wound closure (p = 0.031), had a higher incidence of endophthalmitis.. Results suggest that by suturing the corneal incisions, by initiating antibiotic eye drops within the first 24 h of surgery and by instilling povidone-iodine drops after closure, the incidence of endophthalmitis after cataract surgery could possibly be reduced.

Topics: Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Cornea; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Povidone-Iodine; Retrospective Studies; Risk Factors; Surgical Wound Infection; Sutures

Postoperative endophthalmitis reflects in part quality and safety aspects of cataract surgery. Preoperative 5% povidone-iodine was introduced as a quality improvement effort. This study evaluated the effect of this additional measure on the occurrence of endophthalmitis after cataract surgery.. Topical 5% povidone-iodine solution was applied onto the ocular surface just prior to transferring the patient into the operative theater for cataract surgery. Other prophylactic measures were allowed to continue as before. Patients developing postoperative intraocular inflammation and undergoing intravitreal antibiotic injection were included as occurrences of endophthalmitis. Alteration in endophthalmitis rate was analyzed using a 'p control chart' of a statistical process control method. The incidence in the povidone-iodine-receiving group was compared to those before implementation and concurrent nonreceiving groups.. The postoperative endophthalmitis rate showed a significant reduction after introduction of povidone-iodine. A year before, 9 of 3,052 eyes developed endophthalmitis (0.294%). After introduction, this occurred in 4 of 4,089 eyes receiving povidone-iodine (0.097%) and 1 of 502 nonreceiving eyes (0.199%) in the following 16 months. Despite the apparent lower rate, comparison between groups was not statistically significant. Moderate to severe but tolerable eye irritation after application was reported in 6.6%. No other adverse events were detected.. Topical preoperative 5% povidone-iodine contributed an additional effect to the reduction of the postoperative endophthalmitis rate after cataract surgery. This measure was rather safe to apply as a prophylaxis against endophthalmitis in cataract surgery.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Cataract Extraction; Child, Preschool; Endophthalmitis; Female; Humans; Incidence; Male; Middle Aged; Povidone-Iodine; Preoperative Care; Treatment Outcome

The aim of this study was to assess the risk of postoperative endophthalmitis associated with different prophylactic protocols, using povidone-iodine disinfection of the skin and conjunctiva in patients undergoing cataract surgery over an 8-year period at Chang Gung Memorial Hospital (Kaohsiung, Taiwan).. This was a retrospective, comparative, case-controlled study. Data were collected on patients who received different prophylactic disinfection protocols prior to extracapsular cataract extraction with intraocular lens implantation between January 1992 and January 2000. Possible risk factors for the occurrence of postoperative endophthalmitis were analyzed.. Medical charts for a total of 10,614 extracapsular cataract extraction surgeries performed during the 8-year period were reviewed, and 12 eyes that developed postoperative endophthalmitis were identified and analyzed. Another 120 eyes matched for age and gender of the patient were randomly selected as controls. Skin preparation with 5% povidone-iodine was associated with an increased risk of postoperative infection, compared to that of 10% povidoneiodine. On the conjunctiva, a lack of 5% povidone-iodine disinfection was associated with an increased risk of postoperative infection, compared to 5% povidone-iodine disinfection.. Preoperative skin disinfection with 10% povidone-iodine and conjunctival disinfection with 5% povidone-iodine significantly reduced the relative risk of postoperative endophthalmitis.

Topics: Aged; Anti-Infective Agents, Local; Case-Control Studies; Cataract Extraction; Disinfection; Endophthalmitis; Eye Infections; Female; Humans; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Preoperative Care; Retrospective Studies; Risk Factors; Skin

To compare the reduction of conjunctival bacterial flora by povidone-iodine 4%, ofloxacin 0.3%, and chlorhexidine 0.05% for endophthalmitis prophylaxis before corneal suture removal in an outpatient setting.. In each group of 25 consecutive subjects who presented for outpatient ophthalmic evaluation, one eye was treated with either povidone-iodine 4% (PI), ofloxacin 0.3% (Oflox) or chlorhexidine 0.05% (Chex). The other eye served as a control. Three minutes after treatment, cultures were taken from the inferior conjunctival sac in both eyes. Following incubation at 35 degrees for 48 hours, the numbers of colonies were counted and compared. The difference in the numbers of colonies in each pair of treated and control eyes was assessed for each drug and compared.. The reduction in colony-forming units was highly significant for each of the three drugs tested (Wilcoxon signed-ranks test; p < 0.0001). There was no significant difference between percent reduction by the three drugs (Kruskal-Wallis test; p = 0.68). Sterile cultures following preparation by PI, Oflox and Chex were obtained in 52%, 68% and 52%, respectively.. The regimens tested were similarly effective in reducing conjunctival commensals. They may all be considered as options for a quick prophylaxis against infection following suture removal in an outpatient setting.

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteria; Chlorhexidine; Colony Count, Microbial; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Humans; Ofloxacin; Ophthalmic Solutions; Outpatients; Povidone-Iodine

Topics: Acute Disease; Anti-Infective Agents; Antibiotic Prophylaxis; Cataract Extraction; Ciprofloxacin; Endophthalmitis; Eye Infections, Bacterial; Humans; Incidence; Lens Implantation, Intraocular; Povidone-Iodine; Retrospective Studies; Texas

Topics: Anti-Infective Agents; Cataract Extraction; Endophthalmitis; Humans; Incidence; Lens Implantation, Intraocular; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Practice Guidelines as Topic; United States

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Endophthalmitis; Humans; Ophthalmic Solutions; Povidone-Iodine

To report the incidence of postoperative endophthalmitis in a series of patients who had cataract surgery with intraocular lens (IOL) implantation and to apply guidelines toward the prevention of postoperative endophthalmitis.. The Buzard Eye Institute for Corneal, Refractive and Cataract Surgery, Las Vegas, Nevada, USA.. In this prospective institutional study, 5,131 cataract surgery cases with IOL implantation were performed from 1998 to 2002 by 1 surgeon at a single institute. The surgeon used a blue-line incision at the superior location, povidone- iodine prophylaxis, and postoperative injection of subconjunctival antibiotics. The incidence of endophthalmitis in the study was compared with the general incidence in the United States (range 0.07% to 0.13%) and in published studies (range 0.02% to 0.57%).. The 5,131 cases were followed for a mean of 2 years (range 3 months to 4 years). The mean patient age was 69.6 years +/- 10.9 (SD). No case of endophthalmitis occurred. The zero incidence of endophthalmitis was below the general incidence in the United States and in published studies.. The findings suggest that the absence of postoperative endophthalmitis may be related to 4 factors: povidone-iodine prophylaxis, meticulous draping of the eyes, operative technique (blue-line incision), and postoperative injection of subconjunctival antibiotics.

Topics: Aged; Anti-Infective Agents; Cataract Extraction; Endophthalmitis; Humans; Incidence; Lens Implantation, Intraocular; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Practice Guidelines as Topic; Prospective Studies; Surgical Equipment; United States

General primer-mediated ribosomal DNA amplification during endophthalmitis may improve the quality of diagnostic microbiology. However, extreme care needs to be taken not to introduce contaminating bacterial DNA during surgery procedures. The use of decontaminating iodine solutions can lead to such contamination due to the presence of DNA from Pseudomonas-like organisms.

Topics: Anti-Infective Agents, Local; DNA, Bacterial; Endophthalmitis; Equipment Contamination; Eye Infections, Bacterial; Humans; Povidone-Iodine; Pseudomonas; Vitrectomy

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Conjunctiva; Endophthalmitis; Eye Infections, Bacterial; Humans; Postoperative Complications; Povidone-Iodine

Topics: Ambulatory Surgical Procedures; Cataract Extraction; Disinfection; Endophthalmitis; Humans; Povidone-Iodine; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cataract Extraction; Endophthalmitis; Humans; Ophthalmology; Postoperative Complications; Povidone-Iodine; Practice Patterns, Physicians'; Prevalence; Surveys and Questionnaires; United Kingdom

Most studies of corneal donor contamination concentrate on postenucleation contamination of the eyeball. The purpose of the present study was to evaluate the relative contamination of in situ excised corneal tissue and relevance to final success or rejection by recipients of the corneal grafts.. Ninety-three donors underwent anterior chamber puncture (ACP) and corneal epithelium scarification (CS) before and after disinfection with 5% povidone-iodine. Following in situ excision, corneas were preserved in culture medium at +35 degrees C. Morphological and bacteriological assessment was carried out after culture, and recipients were followed up over a 2-year period.. Samples taken by ACP, CS before disinfection, CS after disinfection and a culture medium sample were contaminated by bacteria in, respectively, 8 (8.6%), 23 (24.7%) 4 (4.3%) and 5 (5.4%) donors. Contamination of aqueous humor was significantly associated with age, death-to-sample time and premortem systemic infection. Contamination of epithelium significantly increased culture medium contamination.. External bacteria on donor cornea are mainly skin bacteria (especially Staphylococcus) and can be partially eliminated by a povidone-iodine wash. Internal bacteria are mainly gut bacteria and may be due to perimortem bacteriemia. However, bacterial infection at the time of death appears to have no effect on the incidence of endophthalmitis in recipients and should no longer prevent use of such corneal tissue in grafts.

Topics: Adult; Aged; Aged, 80 and over; Aqueous Humor; Bacteria; Cornea; Corneal Transplantation; Culture Media; Disinfection; Endophthalmitis; Epithelium, Corneal; Female; Graft Rejection; Humans; Male; Middle Aged; Povidone-Iodine; Risk Factors; Sclera; Tissue Donors; Tissue Preservation

Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Bacteria; Ciprofloxacin; Drug Therapy, Combination; Endophthalmitis; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Ofloxacin; Ophthalmologic Surgical Procedures; Povidone-Iodine; Time Factors

Topics: Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Humans; Povidone-Iodine; Suture Techniques

To determine the incidence of culture-positive endophthalmitis after cataract surgery in an ambulatory surgical care center and to analyze the effectiveness of povidoneiodine solution in the preoperative preparation in preventing culture-positive endophthalmitis.. A retrospective series of 19,269 consecutive cases of cataract extraction with lens implantation over 12 years in an ambulatory care center was reviewed.. Nine cases of culture-positive endophthalmitis occurred, for an incidence of 0.05%. The initial 4,740 cases (1985-1989) were performed without the use of povidone-iodine; the following 14,529 cases (1990-1996) were done using povidone-iodine. The incidence of culture-positive endophthalmitis was 0.08% and 0.03%, respectively.. The incidence of culture-positive endophthalmitis in this series was very low. The use of 5% povidone-iodine, topically, appeared to be beneficial in reducing the incidence of culture-positive endophthalmitis after cataract extraction (P=0.24), but was not statistically significant in this retrospective series. Evaluation and methods to prevent endophthalmitis are difficult in retrospective clinical studies due to multiple variables and the rarity of this complication.

Topics: Ambulatory Care Facilities; Ambulatory Surgical Procedures; Anti-Infective Agents, Local; Bacteria; Cataract Extraction; Colony Count, Microbial; Endophthalmitis; Eye Infections, Bacterial; Humans; Incidence; Lens Implantation, Intraocular; Povidone-Iodine; Retrospective Studies

Topics: Anti-Infective Agents, Local; Conjunctivitis; Endophthalmitis; Humans; Ophthalmic Solutions; Postoperative Complications; Povidone-Iodine

To document perioperative prophylactic treatment and to evaluate the risk factors for endophthalmitis after cataract surgery.. Cross-sectional study via anonymous survey.. Four hundred sixty-nine centers in Germany were queried.. A total of 311 (67%) questionnaires were received, with each center reporting an average of 900 cataract surgeries per year (total, 340,633 surgeries in 1996). Respondents reported a total of 267 cases of endophthalmitis, which resulted in a mean responder-specific endophthalmitis rate of 0.148% versus a median rate of 0%. Statistical analysis via Poisson regression suggested that sclerocorneal incisions were associated with a reduced incidence of endophthalmitis (odds ratio, 0.35; 95% confidence interval, 0.24-0.51). Antibiotics used intraocularly (odds ratio, 0.65; 95% confidence interval, 0.43-0.98) and the preoperative application of diluted povidone-iodine on the conjunctiva (odds ratio, 0.59; 95% confidence interval, 0.36-0.99) were associated with a reduced risk of postoperative infection. Immune deficiencies (66%), diabetes mellitus (62%), occlusion of the lacrimal system (40%), and skin diseases (33%) were regarded as risk factors for endophthalmitis by the respondents. When cataract surgery is performed solely under inpatient conditions, the use of systemic antibiotics as well as the periocular injection of antibiotics at the end of the operation were associated (although not significantly) with a trend toward reducing the incidence of postoperative infection. Conversely, flushing the lacrimal drainage system, using eye shields, and cutting the eyelashes had no demonstrable effect in preventing endophthalmitis. The use of preoperative topical antibiotics (odds ratio, 2.38; 95% confidence interval, 1.21-4.68) and the performance of more than 20% of the surgeries in an outpatient center (odds ratio, 2.0; 95% confidence interval, 1.24-3.21) were associated with a detrimental effect on the development of endophthalmitis.. Although the appropriate antibiotic agent and dosage are not yet established, the administration of intracameral antibiotics and the application of povidone-iodine on the conjunctiva significantly reduced the relative risk of postoperative endophthalmitis in this survey. Because the study was not individual based but rather on aggregate questionnaire, the results have to be interpreted with care.

Topics: Ambulatory Care; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cataract Extraction; Cross-Sectional Studies; Drug Therapy, Combination; Endophthalmitis; Germany; Health Surveys; Humans; Incidence; Odds Ratio; Povidone-Iodine; Risk Factors; Surveys and Questionnaires

Most germs causing postoperative endophthalmitis derive from the conjunctival bacterial normal flora. Postoperative endophthalmitis is often induced by staphylococcal germs. The application of polyvidone-iodine solution to the conjunctiva is one possibility to reduce potential endophthalmitis-causing bacteria. The aim of this study was to evaluate the effectiveness of 1% polyvidone-iodine solution concerning the reduction of colonization with staphylococci in the course of intraocular surgery. This is to evaluate the effectiveness of 1% polyvidone-iodine solution concerning coagulase-negative and positive staphylococci.. Patients with intrabulbar surgery (300) had three conjunctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after antisepsis with polyvidone-iodine before opening the conjunctiva. At the end of surgery the third smear was taken.. In 30.3% staphylococci were isolated from eyes before disinfection. Some patients (7.7%) were staphylococci-positive after disinfection; 5.3% of the patients showed staphylococcal growth at the end of surgery. To evaluate the effectiveness of polyvidone-iodine 1% solution we compared the first and the second smear (Mc Nemar). We found a statistically significant reduction (P < 0.001). At the end of surgery the conjunctival colonization with staphylococcal germs remained statistically significant reduced (P < 0.001). The mean operation time was 37 +/- 24 min.. We concluded that a significant reduction of a staphylococcal colonization can be achieved by preoperative application of polyvidone-iodine (1%) (P < 0.001). Even at the end of surgery the effect of 1% polyvidone-iodine solution held.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Conjunctiva; Drug Therapy, Combination; Endophthalmitis; Gramicidin; Humans; Neomycin; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Polymyxin B; Postoperative Complications; Povidone-Iodine; Premedication; Retrospective Studies; Solutions; Staphylococcus

Propionibacterium acnes has been described as a causative agent of postoperative endophthalmitis. This gram-positive, immotile, non-spore-forming bacterium is highly pleomorphic and grows under conditions of low to no oxygen concentration. It is commonly found on the skin at the openings of sebaceous glands and on hairs. A near-symptomless postoperative endophthalmitis occurs particularly when Propionibacteria are enclosed in the capsular bag. We investigated to what extent the number of P. acnes in the conjunctival sac can be reduced by preoperative disinfection with polyvidone iodine (1%).. A total of 261 patients with intrabulbar surgery had two conjuctival swabs taken: the first immediately prior to preoperative preparation in the operating theatre, following in-patient application of antibiotic eye drops (Polymyxin-B-sulfat, Neomycinsulfat and Gramicidin in combination); the second swab was taken after disinfection with polyvidone iodine before opening the conjunctiva.. Of the 261 swabs, 60 (23%) taken prior to polyvidone iodine application were positive for Propinibacterium acnes. Following polyvidone iodine treatment, a further 5 (1.9%) remained culture-positive. After disinfection, 55 (92%) of the 60 positive swabs for Propionibacterium acnes remained culture-negative.. We concluded that a significant reduction of P. acnes can be achieved by preoperative application of polyvidone iodine (1%) (P < 0.001).

Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Conjunctiva; Endophthalmitis; Eye Diseases; Humans; Microbial Sensitivity Tests; Povidone-Iodine; Preoperative Care; Propionibacterium acnes; Surgical Wound Infection

Topics: Anti-Infective Agents, Local; Endophthalmitis; Eye Infections, Bacterial; Humans; Povidone-Iodine

Povidone-iodine 5% solution decreases the incidence of postoperative endophthalmitis when used on the eye for preoperative preparation. We sought to determine whether it also minimized conjunctival bacterial flora immediately after surgery by preventing bacteria present on the surface of the eye from entering surgical wounds.. In 42 eyes of 40 patients, at the conclusion of surgery, on an alternating basis, each patient received either a drop of a broad-spectrum antibiotic solution (polymyxin B sulfate-neomycin sulfate-gramicidin) or a 5% povidone-iodine solution in the operated-on eye. Bacterial cultures were taken before and after surgery and 24 hours later. The 38 unoperated-on eyes in the unilateral cases served as control eyes.. Relative to the control group, povidone-iodine was effective in preventing an increase in the number of colony-forming units (P = .035), while the antibiotic was not. At 24 hours after surgery, the species count was lower in the eyes receiving povidone-iodine than in the antibiotic-treated eyes (P = .034) and was increased in the antibiotic group since the completion of surgery (P = .013), but was lower in the povidone-iodine and antibiotic groups than in the control eyes for both groups (P < .01).. Povidone-iodine 5% solution applied to the eye at the conclusion of surgery was more effective at minimizing the number of colony-forming units and species for the first postoperative day than was a broad-spectrum antibiotic. While not true for the antibiotic, the antimicrobial effect of povidone-iodine lasted for at least 24 hours after the completion of surgery.

Topics: Bacteria; Colony Count, Microbial; Conjunctiva; Drug Therapy, Combination; Endophthalmitis; Eye Diseases; Eye Infections, Bacterial; Gramicidin; Humans; Neomycin; Ophthalmic Solutions; Polymyxin B; Povidone-Iodine; Surgical Wound Infection

Topics: Cataract Extraction; Endophthalmitis; Humans; Postoperative Complications; Povidone-Iodine; Therapeutic Irrigation

Preoperative eyes which had been treated with gentamicin for one-half day were subjected to one of two povidone-iodine (PI) preparations. The control eye was prepared using a previously described 5% PI one-drop technique, while the paired eye was irrigated with a 0.02% PI solution. Aerobic and anaerobic bacterial cultures were taken of each eye before and after PI applications. Statistical analysis of the data indicates that both techniques were equally effective in reducing surface colonization of the anaerobic cocci and bacilli, the viridans streptococci and micrococci. Both methods were also equally ineffective in reducing the numbers of coagulase-negative staphylococci from the surface of the eye. With the apparent emergence of gentamicin-resistant coagulase-negative staphylococci the potential for staphylococcal endophthalmitis is increasing.

Topics: Colony Count, Microbial; Endophthalmitis; Eye Diseases; Humans; Military Personnel; Postoperative Complications; Povidone-Iodine; Preoperative Care; Staphylococcal Infections; Therapeutic Irrigation

Even though advances in aseptic care have reduced the incidence of endophthalmitis, the conjunctiva still is not sterilized for surgery. This article presents a simple preoperative preparative procedure which, in a series of 225 surgical cases, reduced the incidence of positive postoperative cultures to 9.6%, a much lower percentage than has been reported previously.

Topics: Conjunctiva; Drug Evaluation; Endophthalmitis; Gentamicins; Humans; Ophthalmologic Surgical Procedures; Povidone; Povidone-Iodine; Premedication; Surgical Wound Infection