povidone-iodine and Strabismus

To investigate the effects of topical application of ophthalmic 5% povidone-iodine eye drops, which has been reported to cause apnea in spontaneously breathing children during general anesthesia.. The authors conducted a randomized, controlled, single-blinded study comparing the effect of balanced salt solution eye drops and povidone-iodine eye drops on respiration in spontaneously breathing children during general anesthesia with sevoflurane via a laryngeal mask airway. Fifty patients received balanced salt solution eye drops and 50 patients received 5% povidone-iodine eye drops.. None of the control patients had a significant change in respiration. Thirty of the 50 (60%) povidone-iodine patients had a slowing of respiration within the first 6 breaths after eye drop instillation (P < .001). The median time of respiratory pause in those 30 patients was 18.5 seconds (range: 4.36 to 96.2 seconds). Among the povidone-iodine patients, children with a history of a prior tonsillectomy and adenoidectomy and/or bilateral myringotomy had a 7.2 times greater chance of experiencing a change in respiration after instillation of the povidone-iodine eye drops.. Topical application of 5% povidone-iodine eye drops causes a slowing and pause in spontaneous ventilation in a majority of children prior to strabismus surgery. This may represent activation of the diving reflex. [J Pediatr Ophthalmol Strabismus. 2019;56(6):378-382.].

Topics: Adolescent; Anesthesia, General; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Humans; Instillation, Drug; Male; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Povidone-Iodine; Preoperative Care; Respiratory Rate; Single-Blind Method; Strabismus; Treatment Outcome

Although the association between suture colonization and postoperative infections remains hypothetical, measures to reduce perioperative suture colonization may minimize postoperative infections. The suture colonization rate in adjustable suture strabismus surgery is not well defined, and the effect of povidone-iodine use on suture colonization is unknown.. To assess whether povidone-iodine application at the end of adjustable suture strabismus surgery decreases the suture colonization rate.. In this randomized clinical trial designed in 2015 and performed from June 1 through October 31, 2015, a total of 65 adjustable and 43 control suture specimens from 65 demographically similar adults undergoing adjustable suture strabismus surgery were studied. A random sampling assigned participants into group 1 (with povidone-iodine) or group 2 (without povidone-iodine) at the end of surgery. A control suture specimen was obtained if ipsilateral nonadjustable surgery was performed. Both groups received antibiotic ointment at the end of the procedure. No patients refused participation or withdrew. Data analysis was performed from October 1 to December 31, 2015. Observers were unaware of patient grouping.. One drop of 5% povidone-iodine directly over the sliding noose of the adjustable suture at the end of surgery.. The suture colonization rate after adjustment in group 1, group 2, and the control group.. Of 65 adults undergoing surgery, there were 17 men (49%) and 18 women (51%) in group 1 and 10 men (33%) and 20 women (67%) in group 2, as well as 20 men (47%) and 23 women (53%) in the control group. The mean (SD) age of the patients was 48.5 (16.8) years in group 1, 46.6 (18.1) years in group 2, and 47.7 (17.0) years in the control group. There was no difference in the colonization rate between group 1 (57%) and group 2 (47%) (relative risk [RR], 1.1; 95% CI, 0.6-1.7; P = .80), group 1 and the control group (44%) (RR, 1.0; 95% CI, 0.5-1.8; P > .99), or group 2 and the control group (RR, 1.3; 95% CI, 0.8-2.1; P = .62). Eleven bacterial species were identified. Staphylococcus epidermidis was the predominant isolate (40 of 56 [71%]). A longer interval between the end of surgery and adjustment was associated with higher culture positivity (6.3 hours in positive vs 4.4 hours in negative cultures, P = .001); however, there was no difference in bacterial growth between the groups. No adverse effects of povidone-iodine were observed.. This study was not able to demonstrate that povidone-iodine at the end of adjustable suture strabismus surgery reduces the suture colonization rate.. clinicaltrials.gov Identifier: NCT02424357.

Topics: Administration, Topical; Adult; Anti-Infective Agents, Local; Colony Count, Microbial; Eye Infections, Bacterial; Female; Follow-Up Studies; Humans; Male; Middle Aged; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Povidone-Iodine; Retrospective Studies; Strabismus; Surgical Wound Infection; Suture Techniques; Sutures; Time Factors

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 identify and analyze cases of postoperative infection following strabismus surgery at a large referral center and to report the incidence, risk factors, and outcomes.. An electronic database search identified strabismus procedures at Duke Eye Center from July 1996 to October 2017. Diagnosis codes for periocular infections were used to further identify patients with possible infections following strabismus surgery.. Of 9,111 strabismus surgeries, 13 (0.14%) met criteria for probable infection, all occurring since October 2012 (0/6580 before vs 13/2531 [0.51%] after; P < 0.0001). Mean age of infection cases was 11.4 years; 11 patients (85%) were under 18 years of age. Associated previous diagnoses were genetic abnormalities with associated developmental delay (n = 5 [38%]), previous skin or ear infection (n = 4 [31%]), and acute or chronic rhinitis (n = 3 [23%]). Infection site cultures revealed methicillin-resistant Staphylococcus aureus (n = 3 [23%]), methicillin-sensitive S. aureus (n = 3 [23%]), and Streptococcus pyogenes/group-A Streptococcus (n = 2 [15%]). Only 1 case had bilateral infection. Infection remained extraocular in all cases, but one eye lost light perception secondary to optic atrophy. No common surgeon/procedure/preparation-related risks were identified.. A unifying explanation for the increase in post-strabismus surgery infections at Duke Eye Center was not identified. Potential risk factors include age <18 years, developmental delay, immune compromise, preceding nonocular infection, and bacterial colonization.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Child; Child, Preschool; Female; Humans; Injections, Intraocular; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Oculomotor Muscles; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Povidone-Iodine; Preoperative Care; Prospective Studies; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Strabismus; Streptococcal Infections; Streptococcus pyogenes; Surgical Wound Infection; Treatment Outcome; Young Adult

Topics: Anti-Infective Agents, Local; Apnea; Child; Humans; Povidone-Iodine; Sterilization; Strabismus

Presurgical preparation for ocular surgery typically utilizes a buffered 5% povidone-iodine preparation solution. It was our observation that a significant number of spontaneously ventilating patients under sevoflurane anesthesia would become apneic upon ophthalmic instillation of this solution. This study was performed to confirm or refute this observation and to determine whether there were any patient variables that might predict this phenomenon.. After Institutional Review Board (IRB) approval, thirty pediatric patients scheduled for strabismus surgery were enrolled. Anesthesia was induced and maintained with sevoflurane via laryngeal mask airway, and all patients were breathing spontaneously. All patients received preoperative sedation with oral midazolam (0.5 kg·kg(-1), maximum 12 mg). Presurgical preparation was performed with saline wash followed by instillation of buffered 5% povidone-iodine solution. Respiratory rate was recorded at the time of surgical preparation. Apnea was defined as lack of respiratory effort for 20 s or greater.. Data from twenty-eight children (ages 1.4-11 years) were ultimately recorded. Fifteen of the twenty-eight patients developed apnea (median duration 40, IQR 37, range 20-262 s) at the time of surgical site preparation.. Apnea at the time of ocular preparation with buffered 5% povidone-iodine solution is common. The precise mechanism of this response is unknown.

Topics: Anti-Infective Agents, Local; Apnea; Child; Child, Preschool; Female; Humans; Infant; Intraoperative Complications; Male; Povidone-Iodine; Preoperative Care; Strabismus

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

Infection after strabismus surgery is rare. Here we describe a 5-year-old girl who developed bilateral staphylococcal sub-Tenon's abscess resistant to fourth-generation fluoroquinolones that resolved completely after surgical drainage and irrigation with povidone iodine followed by administration of oral amoxicillin and clavulanic acid. A lost muscle required exploration and reattachment to the sclera.

Topics: Abscess; Anti-Bacterial Agents; Child, Preschool; Combined Modality Therapy; Connective Tissue Diseases; Eye Infections, Bacterial; Female; Functional Laterality; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Postoperative Complications; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus; Strabismus; Suction; Therapeutic Irrigation

While antibiotic/steroid combinations are routinely administered during the first week after strabismus surgery, they can be costly and inconvenient and may be unnecessary. This study compares the use of single-dose 5% povidone-iodine drops versus a week-long course of antibiotic/steroid as a prophylaxis against postoperative infection in extraocular muscle surgery.. Retrospective chart review was performed of 1871 patients undergoing routine strabismus surgery. Patients received either a single application of 5% povidone-iodine solution to the operative eye(s) at the conclusion of the surgical procedure or a week-long course of topical antibiotic/steroid. Postoperative records were then reviewed to identify abnormalities or complications occurring during the first 2 months after surgery.. Complete documentation was found for 1603 patients. Single-dose povidone-iodine prophylaxis was used in 953 cases (59.5%), and a postoperative course of topical antibiotic/steroid combination was used in 650 cases (40.5%). Of the 1603 cases, possible infection occurred in 46 patients (2.87%). Of the 46 possible infections, 20 (3.08%) occurred in 650 patients on an antibiotic/steroid combination and 26 (2.83%) occurred in the 953 patients treated with single-dose povidone-iodine prophylaxis. This difference was not statistically significant (p = 0.6815). No cases of orbital cellulitis or endophthalmitis occurred in either group.. Single-dose povidone-iodine is an inexpensive alternative to postoperative antibiotic/steroid prophylaxis following routine strabismus surgery performed through a fornix incision. Patients who had reoperations and limbal incisions were more likely to have complicated postoperative courses: antibiotic/steroid use in these groups may be beneficial.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Local; Child; Child, Preschool; Dexamethasone; Drug Therapy, Combination; Follow-Up Studies; Glucocorticoids; Humans; Incidence; Infant; Middle Aged; Ophthalmic Solutions; Ophthalmologic Surgical Procedures; Postoperative Care; Povidone-Iodine; Retrospective Studies; Strabismus; Surgical Wound Infection; Tobramycin; Treatment Outcome; Young Adult

Topics: Humans; Oculomotor Muscles; Pilot Projects; Povidone-Iodine; Protective Clothing; Strabismus; Surgical Wound Infection