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Soleimani M, Haydar AA, Cheraqpour K, Zeidabadinejad H, Esfandiari A, Eshaghhosseiny N, Shahmohammadi A, Banz S, Djalilian AR. In praise of povidone-iodine application in ophthalmology. Surv Ophthalmol 2023:S0039-6257(23)00143-1. [PMID: 37944600 DOI: 10.1016/j.survophthal.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/26/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
Polyvinyl pyrrolidone or povidone-iodine (PVP-I) is a water-soluble complex formed by the combination of iodine and a water-soluble polymer, polyvinyl pyrrolidone. This complex exerts bactericidal, fungicidal, and virucidal action by gradually releasing free iodine at the site of application to react with pathogens. In ophthalmology, PVP-I is used as a disinfectant and antiseptic agent for preoperative preparation of the skin and mucous membranes and for treating contaminated wounds. PVP-I has been shown to reduce effectively the risk of endophthalmitis in various ocular procedures, including cataract surgery and intravitreal injections; however, it has also been used in the treatment of conjunctivitis, keratitis, and endophthalmitis, with promising results especially in low-resource situations. PVP-I has been associated with complications such as postoperative eye pain, persistent corneal epithelial defects, ocular inflammation, and an attendant risk of keratitis. In cases of poor PVP-I tolerance, applying PVP-I at lower concentrations or using alternative antiseptics such as chlorhexidine should be considered. We provide an update on the efficacy of PVP-I in the prophylaxis and treatment of conjunctivitis, keratitis, and endophthalmitis and a comprehensive analysis of the current literature regarding the use of PVP-I in the management of these ocular conditions. Also, PVP-I-related adverse effects and toxicities and its alternatives are discussed. The goal is to present a thorough evaluation of the available evidence and to offer practical recommendations for clinicians regarding the therapeutic usage of PVP-I in ophthalmology.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ali A Haydar
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Haniyeh Zeidabadinejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirreza Esfandiari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | - Soraya Banz
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; University of Edinburgh, UK.
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.
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Uner OE, Lee D, Horesh R, Jewart B, Seebruck C. Lowering the Incidence of Endophthalmitis Following Intravitreal Anti-VEGF Injection: An Analysis of Aseptic Protocol Adjustment. Ophthalmic Surg Lasers Imaging Retina 2023; 54:520-525. [PMID: 37642415 DOI: 10.3928/23258160-20230808-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE 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. PATIENTS AND METHODS 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. RESULTS 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%; P = 0.001). There was no significant difference in the best-corrected visual acuity between groups. Highly virulent bacteria were predominantly isolated in Group 1, but proportions of gram-positive bacterial growth were similar. CONCLUSIONS 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. [Ophthalmic Surg Lasers Imaging Retina 2023;54:520-525.].
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Effect of topical povidone-iodine 10% plus levofloxacin 0.5% 1 hour before cataract surgery in eliminating perioperative conjunctival flora: randomized clinical trial. J Cataract Refract Surg 2021; 47:340-344. [PMID: 32947383 DOI: 10.1097/j.jcrs.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of a single administration of topical povidone-iodine (PVI) 10% plus levofloxacin 0.5% at 1 hour before cataract surgery on perioperative elimination rate of conjunctival flora. SETTING Poostchi Ophthalmology Research Center, Shiraz, Iran. DESIGN Randomized controlled trial. METHOD Patients who required cataract surgery were randomly assigned to 1 of 2 groups: intervention (administration of PVI 10% plus levofloxacin 0.5% at 1 hour preoperatively) or control. The patients in both groups received PVI just before the operation. Conjunctival cultures were obtained using thioglycollate broth at 4 timepoints: T1, before intervention; T2, before the second application of PVI; T3, 3 minutes after the second administration of PVI; and T4, just postoperatively. RESULTS The study comprised 142 patients. The comparative rates of positive cultures in the intervention vs control groups were as follows: T1 (70.4% vs 73.2%, P = .709); T2 (15.5% vs 71.8%, P < .001); T3 (7.0% vs 19.7%, P = .027); and T4 (5.6% vs 4.2%, P = .698). Coagulase-negative Staphylococci was the most common isolated microorganism. CONCLUSIONS Results showed that a single adjuvant application of PVI 10% plus levofloxacin 0.5% eyedrops at 1 hour before operation leads to a further increase in the rate of sterile conjunctiva just preoperatively.
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Budzinskaya MV, Khalatyan AS, Strakhovskaya MG, Zhukhovitsky VG. Ocular flora in patients undergoing intravitreal injections: antibiotic resistance patterns and susceptibility to antiseptic picloxydine. Int J Ophthalmol 2020; 13:85-92. [PMID: 31956575 DOI: 10.18240/ijo.2020.01.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To study antibiotic resistance patterns and susceptibility to eye antiseptic picloxydine of conjunctival flora in patients undergoing intravitreal injections (IVIs). METHODS Conjunctival swabs were taken in 4 groups of patients, 20 patients in each group (n=80): without IVIs and ophthalmic operations in history (group N1; control group); with the first IVI and antibiotic eye drops Tobrex applied 3d before IVI and 5d after it (group N2); with 20 or more IVIs and repeated courses of antibiotic eye drops (group N3); with the first IVI and antiseptic eye drops Vitabact (picloxydine) applied 3d before IVI and 5d after it (group N4). In groups N2 and N4 swabs were taken at baseline and after the treatment. Efficacy of picloxydine in inhibition of growth of conjunctival isolates susceptible and resistant to antibiotic was studied in vitro. Minimal inhibition concentrations (MIC) were determined with microdilution test. RESULTS Two of the three patients who had to undergo the IVI procedure showed conjunctiva bacterial contamination. Along with few Staphylococcus aureus and Gram-negative isolates susceptible to most antibiotics, the majority (71%-77%) of causative agents were coagulase-negative Staphylococci (CoNS), 40%-50% of which were multidrug resistant (MDR). Eye disinfection in the operating room and peri-injection courses of Tobrex or Vitabact resulted in total elimination of isolates found at baseline. However, in 10% and 20% of patients, respectively, recolonization of the conjunctiva with differing strains occurred. In patients with repeated IVI and Tobrex/Maxitrol treatment, the conjunctival flora showed high resistance rates: 90% of CoNS were MDR. In the in vitro study, picloxydine showed bactericidal effect against Staphylococci isolates both antibiotic resistant and susceptible with MIC≥13.56 µg/mL. Incubation of bacteria for 15min in Vitabact eye drops, commercially available form of picloxydine, 434 µg/mL, showed total loss of colony forming units of all tested isolates including Pseudomonas aeruginosa. CONCLUSION The confirmed efficacy of eye antiseptic picloxydine against conjunctival bacterial isolates and the presence of its commercial form, 0.05% eye drops, convenient for use by patients before and after injection, make this eye antiseptic promising for prophylaxis of IVI-associated infectious complications.
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Affiliation(s)
| | - Anait S Khalatyan
- Scientific Research Institute of Eye Diseases, Moscow 119021, Russia
| | - Marina G Strakhovskaya
- Department of Biology, Lomonosov Moscow State University, Moscow 119234, Russia.,Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Medical and Biological Agency of Russia, Moscow 115682, Russia
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Patel SN, Gangaputra S, Sternberg P, Kim SJ. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol 2020; 65:408-420. [PMID: 31923477 DOI: 10.1016/j.survophthal.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
Intravitreal injections have become the most commonly performed ophthalmic procedure, transforming modern retina practice. Postinjection endophthalmitis, while rare, remains the most feared potential complication. Prophylaxis measures including topical antisepsis, hand hygiene, gloves, masks, and drapes have all been proposed to help prevent postinjection endophthalmitis; however, there remains significant variation in protocol, given the lack of agreement among retina specialists on which steps are crucial to prevent endophthalmitis. With millions of injections performed annually, collating data have helped us better understand risk factors for endophthalmitis after intravitreal injection. We summarize the consensus guidelines for intravitreal injection technique and comprehensively review the literature on prevention of postinjection endophthalmitis.
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Affiliation(s)
- Shriji N Patel
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Sapna Gangaputra
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul Sternberg
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Stephen J Kim
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Ing MR, Shortell J, Golez J. Extraocular and Intraocular Infections Following Strabismus Surgery: A Review. J Pediatr Ophthalmol Strabismus 2019; 56:214-221. [PMID: 31322710 DOI: 10.3928/01913913-20190425-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].
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Musumeci R, Bandello F, Martinelli M, Calaresu E, Cocuzza CE. In vitro bactericidal activity of 0.6% povidone-iodine eye drops formulation. Eur J Ophthalmol 2018; 29:673-677. [PMID: 30295039 DOI: 10.1177/1120672118802541] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the bactericidal activity of a diluted povidone-iodine formulation (0.6%) in comparison with the most used 5% povidone-iodine solution ophthalmic preparation. METHODS In vitro bactericidal activity comparison between 0.6% povidone-iodine versus 5% povidone-iodine formulations, against these bacteria: Staphylococcus aureus ATCC 25923, Staphylococcus aureus ATCC 43300, Staphylococcus epidermidis ATCC 12228, linezolid-resistant Staphylococcus epidermidis α99 strain, a clinical isolate, Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922. RESULTS About 0.6% povidone-iodine formulation was demonstrated to be faster than 5% povidone-iodine preparation in killing Gram-positive as well as Gram-negative bacteria. Against a linezolid-resistant methicillin-resistant Staphylococcus epidermidis strain, 0.6% povidone-iodine formulation showed the best antiseptic efficacy requirement of 3-log10 reduction in bacterial load, if compared with the 5% povidone-iodine formulation. CONCLUSION Our investigation has demonstrated that the more diluted 0.6% preparation was more rapidly bactericidal than the 5% povidone-iodine formulation, most probably due to the fact that dilution from 5% to 0.6% increases the amount of free iodine. While our finding must be confirmed by in vivo clinical studies, this fact constitutes an intriguing news for what concerns the use of povidone-iodine eye drops in the ocular surface treatment before intravitreal injections as well as ophthalmic surgery.
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Affiliation(s)
- Rosario Musumeci
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Marianna Martinelli
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Enrico Calaresu
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Clementina Elvezia Cocuzza
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Hunyor AP, Merani R, Darbar A, Korobelnik JF, Lanzetta P, Okada AA. Topical antibiotics and intravitreal injections. Acta Ophthalmol 2018; 96:435-441. [PMID: 28440583 DOI: 10.1111/aos.13417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/13/2017] [Indexed: 12/28/2022]
Abstract
There is increasing evidence that topical antibiotics, given before and/or after intravitreal injections, are ineffective in preventing endophthalmitis and are possibly harmful. In addition to the lack of efficacy and increased development of resistant organisms, the use of topical antibiotics adds significantly to the cost of delivering intravitreal therapy. Despite this, in many countries, it is still common practice to use pre- and/or postinjection topical antibiotics. This review outlines the general principles of effective antibiotic prophylaxis, and the evidence regarding topical antibiotic use as a prophylactic measure for endophthalmitis following intravitreal injections. A key distinguishing feature of intravitreal injections from most other invasive procedures is the fact that they are often repeated on multiple occasions to the same eye. Given the lack of evidence to support topical antibiotics as an effective method of prophylaxis for postinjection endophthalmitis, it appears that more widespread education of ophthalmologists is required to avoid continued inappropriate use. Revision of drug labels in some jurisdictions, and amendment of local/professional society guidelines, may be required to assist in achieving this goal. Emphasis should be placed on antisepsis and aseptic technique, which are the major proven methods of endophthalmitis prevention, rather than antibiotics.
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Affiliation(s)
- Alex P. Hunyor
- University of Sydney; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
| | - Rohan Merani
- Sydney and Macquarie Universities; Sydney New South Wales Australia
- Concord Repatriation General Hospital; Concord New South Wales Australia
| | - Archie Darbar
- Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Jean-François Korobelnik
- Service d'ophtalmologie; CHU de Bordeaux; Bordeaux France
- Univ. Bordeaux; ISPED; Bordeaux France
- Inserm; U1219 - Bordeaux Population Health Research Center; Bordeaux France
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9
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Gili NJ, Noren T, Törnquist E, Crafoord S, Bäckman A. Preoperative preparation of eye with chlorhexidine solution significantly reduces bacterial load prior to 23-gauge vitrectomy in Swedish health care. BMC Ophthalmol 2018; 18:167. [PMID: 29996791 PMCID: PMC6042411 DOI: 10.1186/s12886-018-0844-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bacteria in the conjunctiva present a potential risk of vitreous cavity infection during 23-gauge pars plana vitrectomy (PPV). Current preoperative procedures used in Sweden include irrigation with chlorhexidine solution (CHX) 0.05% only and no iodine solutions. We evaluated the bacterial diversity and load before and after this single antibacterial measure. Methods In a prospective, consecutive cohort we investigated bacterial growth in samples from 40 eyes in 39 consecutive individuals subjected to vitrectomy. A conjunctival specimen was collected from each preoperative patient before and after irrigating of eye with CHX, 0.05% solution. Iodine was not used during any part of the surgery. One drop of chloramphenicol was administered prior to surgery. Samples from vitreous cavity were collected at the beginning and end of vitrectomy. All conjunctival specimens were cultured for different species and quantified using colony forming units (CFU). Results There was a significant 82% reduction in the total number of CFUs for all bacteria in all eyes (P < 0.0001), and 90% reduction for coagulase negative staphylococci (CoNS) alone (P = 0.0002). The number of eyes with positive bacterial growth in conjunctival samples decreased from 33 to 18 after irrigation with CHX (P = 0.0023). The most common bacteria prior to surgery were CoNS (70%), Propionibacterium acnes (55%) and Corynebacterium species (36%). No case of post-vitrectomy endophthalmitis was reported during mean follow-up time, which was 4.6 ± 2.3 (range; 1.5 to 9) months. Conclusions Patients undergoing PPV harbored bacteria in conjunctiva capable of causing post-vitrectomy endophthalmitis. Preoperative preparation with CHX significantly reduced the bacterial load in the conjunctival samples subsequently leading to very low inoculation rates in recovered vitreous samples. Thus, CHX used as a single disinfectant agent might be an effective preoperative procedure for eye surgery in Sweden. This is a relatively small study but the results could be a reference for other intraocular surgeries.
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Affiliation(s)
- Nasser J Gili
- Department of Ophthalmology, Örebro University Hospital, SE-701 85, Örebro, Sweden.
| | - Torbjörn Noren
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Eva Törnquist
- Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden
| | - Sven Crafoord
- Department of Ophthalmology, Örebro University Hospital, SE-701 85, Örebro, Sweden
| | - Anders Bäckman
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Research Laboratory, Örebro University Hospital, Örebro, Sweden
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Carrim ZI, Mackie G, Gallacher G, Wykes WN. The Efficacy of 5% Povidone-Iodine for 3 Minutes Prior to Cataract Surgery. Eur J Ophthalmol 2018; 19:560-4. [DOI: 10.1177/112067210901900407] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the efficacy of 3 minutes of 5% povidone-iodine for skin and conjunctival antisepsis prior to cataract surgery as recommended by the European Society of Cataract and Refractive Surgeons. Methods A prospective controlled study of 54 patients undergoing unilateral cataract surgery by phacoemulsification was undertaken. The eye undergoing surgery was prepared with 5% povidone-iodine for 3 minutes. The other eye served as control. Swabs were taken from both eyes prior to application of 5% povidone-iodine and 3 minutes after. Proportion of culture-positive swabs, mean number of species, and growth of isolates on culture were compared at different times and between the two groups. Results Coagulase-negative Staphylococcus (CoNS) was the main species isolated from culture-positive swabs. Use of 5% povidone-iodine for 3 minutes resulted in a statistically significant reduction in proportion of culture-positive swabs (87% vs 30%, p<0.001), mean number of species (0.96±0.47 vs 0.30±0.46, p<0.001), and growth of CoNS (heavy: 30% vs 0%, moderate: 23% vs 6%, light: 47% vs 94%, p=0.004). No such changes were observed in the control group. Conclusions Use of 5% povidone-iodine for 3 minutes prior to cataract surgery achieves a significant reduction in organisms such as CoNS from lid and conjunctival flora.
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Affiliation(s)
- Zia I. Carrim
- Department of Ophthalmology, Southern General Hospital, Glasgow - Scotland
| | - Gordon Mackie
- Department of Microbiology, Southern General Hospital, Glasgow - Scotland
| | - Grace Gallacher
- Department of Microbiology, Southern General Hospital, Glasgow - Scotland
| | - William N. Wykes
- Department of Ophthalmology, Southern General Hospital, Glasgow - Scotland
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11
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Arevalo JF, Garcia RA, Mendoza AJ. High-dose (5000-μg) Intravitreal Ganciclovir Combined with Highly Active Antiretroviral Therapy for Cytomegalovirus Retinitis in HIV-Infected Patients in Venezuela. Eur J Ophthalmol 2018; 15:610-8. [PMID: 16167292 DOI: 10.1177/112067210501500512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients. Methods Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of ≥50 cells/μL to levels over 100 cells/μL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included. Results Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%). Conclusions High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.
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Affiliation(s)
- J F Arevalo
- Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela.
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12
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Aslan O, Teberlk K, Yucel M, Gur N, Karakoc A. Effect of Topical Netilmicin on the Reduction of Bacterial Flora on the Human Conjunctiva. Eur J Ophthalmol 2018; 18:512-6. [DOI: 10.1177/112067210801800402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- O. Aslan
- M.H. Ulucanlar Eye Education and Research Hospital, Department of Microbiology, Ankara - Turkey
| | - K. Teberlk
- M.H. Ulucanlar Eye Education and Research Hospital, Department of Microbiology, Ankara - Turkey
| | - M. Yucel
- M.H. Ankara Education and Research Hospital, Department of Microbiology, Ankara - Turkey
| | - N. Gur
- M.H. Ankara Education and Research Hospital, Department of Microbiology, Ankara - Turkey
| | - A.E. Karakoc
- M.H. Ankara Education and Research Hospital, Department of Microbiology, Ankara - Turkey
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13
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Ta C, He L, Nguyen E, De Kaspar HM. Prospective Randomized Study Determining Whether a 3-Day Application of Ofloxacin Results in the Selection of Fluoroquinolone-Resistant Coagulase-Negative Staphylococcus. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210601600301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C.N. Ta
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA - USA
| | - L. He
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA - USA
| | - E. Nguyen
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA - USA
| | - H. Miño De Kaspar
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA - USA
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich - Germany
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14
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Lee D, Lee N, Kwon I. Efficient loading of ophthalmic drugs with poor loadability into contact lenses using functional comonomers. Biomater Sci 2018; 6:2639-2646. [DOI: 10.1039/c8bm00586a] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Funtional comonomers with an anionic group substantially enhanced the amount of two ocular antibiotics loaded to contact lenses.
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Affiliation(s)
- Dasom Lee
- School of Materials Science and Engineering
- Gwangju Institute of Science and Technology (GIST)
- Gwangju
- Republic of Korea
| | - Nohwook Lee
- School of Materials Science and Engineering
- Gwangju Institute of Science and Technology (GIST)
- Gwangju
- Republic of Korea
| | - Inchan Kwon
- School of Materials Science and Engineering
- Gwangju Institute of Science and Technology (GIST)
- Gwangju
- Republic of Korea
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Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial. PLoS One 2017; 12:e0189206. [PMID: 29261737 PMCID: PMC5736199 DOI: 10.1371/journal.pone.0189206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. METHODS Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). RESULTS There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. CONCLUSION Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.
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Effectiveness of meibomian gland massage combined with topical levofloxacin against ocular surface flora in patients before penetrating ocular surgery. Ocul Surf 2017; 16:70-76. [PMID: 28890180 DOI: 10.1016/j.jtos.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/25/2017] [Accepted: 09/06/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the bacterial profile in the conjunctiva and meibomian glands in patients before penetrating ocular surgeries, and to compare the anti-bacterial efficacy of 0.5% levofloxacin and its combination with meibomian gland massage. DESIGN Hospital-based, case-control study. PARTICIPANTS Two hundred and twenty-six eyes from 226 patients with non-infective ocular diseases and scheduled for penetrating ocular surgeries. METHODS Tested eyes were administered topical 0.5% levofloxacin (4 times daily) for 2 days. Among them, 91 eyes received meibomian gland massage before levofloxacin application. Samples from the conjunctival sac and meibomian glands were collected for aerobic and anaerobic cultures. MAIN OUTCOME MEASURES Culture-positivity and bacterial strains. RESULTS Before treatment, aerobes and anaerobes were cultured from 38.5% and 11.0% of the conjunctival samples respectively, compared with 38.5% and 8.8% in the meibomian secretions respectively. Staphylococcus epidermidis and Propionibacterium acnes were the commonest isolated aerobe and anaerobe. Two-day application of levofloxacin reduced aerobic growth to 29.6% in the conjunctiva and 19.3% in the meibomian glands. It had no effect on the anaerobes in these regions (13.3% in the conjunctiva and 10.4% in the meibomian glands). Combined levofloxacin with meibomian gland massage further reduced aerobic growth to 19.8% in the conjunctiva and 11.0% in the meibomian glands. It also drastically decreased anaerobic growth in the meibomian glands (1.1%). CONCLUSIONS Meibomian glands carrying considerable bacteria should be considered as a potential source of contamination in ocular surgery. Meibomian gland massage shows additional anti-bacterial effects to topical levofloxacin and could be recommended as a complementary preoperative prophylaxis.
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Infectious and sterile endophthalmitis after intravitreal injections: differential diagnosis, prevention, treatment. OPHTHALMOLOGY JOURNAL 2017. [DOI: 10.17816/ov10162-69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Endophthalmitis is a rare but extremely severe complication of different intraocular procedures. In the article, we analyze world literature data on prevalence, differential diagnosis, prevention methods, and treatment of endophthalmitis after intravitreal injections.
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Lai HC, Tseng WC, Pao SI, Wong CS, Huang RC, Chan WH, Wu ZF. Relationship between anesthesia and postoperative endophthalmitis: A retrospective study. Medicine (Baltimore) 2017; 96:e6455. [PMID: 28328861 PMCID: PMC5371498 DOI: 10.1097/md.0000000000006455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Previous study showed that patients under general anesthesia (GA) had nasopharyngeal secretions on the face at the end of ocular surgery, especially in propofol-based total intravenous anesthesia (TIVA), it might induce postoperative endophthalmitis. Therefore, we conducted a retrospective study to compare the incidence of endophthalmitis after ocular surgery under topical, inhalation anesthesia, and propofol-based TIVA in our medical center from 2011 to 2015.A total of 21,032 patients were included, and we evaluated epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of ocular surgery, method of antibiotic prophylaxis, vitreous culture, and vision outcome in these patients.Fifteen endophthalmitis cases among 21,032 operations reported, equaling an incidence of 0.071%. The incidence rates under topical, inhalation anesthesia, and propofol-based TIVA were 0.083%, 0.039%, and 0%, respectively (P = 0.39). Moreover, the risk of endophthalmitis under GA (0.024%) was significantly lower than topical anesthesia (0.083%) (P < 0.001). We also found that elder was the risk factor for endophthalmitis following ocular surgery.In conclusion, propofol-based TIVA or inhalation anesthesia did not increase the risk of endophthalmitis after ocular surgery. Thus, GA was not a risk factor for postoperative endophthalmitis. By contrast, elder was the risk factor for postoperative endophthalmitis.
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Affiliation(s)
- Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China
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Anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection. Am J Ophthalmol Case Rep 2016; 5:16-19. [PMID: 29503939 PMCID: PMC5758012 DOI: 10.1016/j.ajoc.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the occurrence and management of severe infectious scleritis in a 75 year-old woman following intravitreal ranibizumab injection. Observations A 75 year-old monocular woman receiving monthly intravitreal ranibizumab injection for wet age related macular degeneration in the left eye presented with severe dull pain, decreased vision, and scleral melt with discharge 2 weeks after her last injection. The dilated fundus exam was devoid of vitritis. The patient was admitted to our hospital for both diagnostic and therapeutic purposes. She was initially started on aggressive oral and topical antibiotics, but showed no significant improvement. The scleral cultures were positive for Pseudomonas aeruginosa. In view of the aggressive nature of her infection, intravenous antibiotics were added to the treatment regimen. The patient recovered her baseline visual function after two weeks of intravenous, oral and, topical antibiotics. Conclusions and importance To our knowledge, this is the first case of anterior infectious necrotizing scleritis secondary to Pseudomonas aeruginosa infection following intravitreal ranibizumab injection. Clinicians performing intravitreal injections should have a high index of suspicion for iatrogenic infections including scleritis and endophthalmitis, as these infections require aggressive topical and systemic antibiotics as well as possible hospitalization.
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Goc A, Niedzwiecki A, Rath M. Cooperation of Doxycycline with Phytochemicals and Micronutrients Against Active and Persistent Forms of Borrelia sp. Int J Biol Sci 2016; 12:1093-103. [PMID: 27570483 PMCID: PMC4997053 DOI: 10.7150/ijbs.16060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/14/2016] [Indexed: 11/05/2022] Open
Abstract
Phytochemicals and micronutrients represent a growing theme in antimicrobial defense; however, little is known about their anti-borreliae effects of reciprocal cooperation with antibiotics. A better understanding of this aspect could advance our knowledge and help improve the efficacy of current approaches towards Borrelia sp. In this study, phytochemicals and micronutrients such as baicalein, luteolin, 10-HAD, iodine, rosmarinic acid, and monolaurin, as well as, vitamins D3 and C were tested in a combinations with doxycycline for their in vitro effectiveness against vegetative (spirochetes) and latent (rounded bodies, biofilm) forms of Borrelia burgdorferi and Borrelia garinii. Anti-borreliae effects were evaluated according to checkerboard assays and supported by statistical analysis. The results showed that combination of doxycycline with flavones such as baicalein and luteolin exhibited additive effects against all morphological forms of studied Borrelia sp. Doxycycline combined with iodine demonstrated additive effects against spirochetes and biofilm, whereas with fatty acids such as monolaurin and 10-HAD it produced FICIs of indifference. Additive anti-spirochetal effects were also observed when doxycycline was used with rosmarinic acid and both vitamins D3 and C. Antagonism was not observed in any of the cases. This data revealed the intrinsic anti-borreliae activity of doxycycline with tested phytochemicals and micronutrients indicating that their addition may enhance efficacy of this antibiotic in combating Borrelia sp. Especially the addition of flavones balcalein and luteolin to a doxycycline regimen could be explored further in defining more effective treatments against these bacteria.
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Affiliation(s)
- Anna Goc
- Dr. Rath Research Institute BV, Santa Clara, California 95050, USA
| | | | - Matthias Rath
- Dr. Rath Research Institute BV, Santa Clara, California 95050, USA
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Reynolds MM, Greenwood-Quaintance KE, Patel R, Pulido JS. Selected Antimicrobial Activity of Topical Ophthalmic Anesthetics. Transl Vis Sci Technol 2016; 5:2. [PMID: 27441100 PMCID: PMC4942249 DOI: 10.1167/tvst.5.4.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/01/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Endophthalmitis is a rare complication of intravitreal injection (IVI). It is recommended that povidone-iodine be the last agent applied before IVI. Patients have reported povidone-iodine application to be the most bothersome part of IVIs. Topical anesthetics have been demonstrated to have antibacterial effects. This study compared the minimum inhibitory concentration (MIC) of topical anesthetic eye drops (proparacaine 0.5%, tetracaine 0.5%, lidocaine 2.0%) and the antiseptic, 5.0% povidone-iodine, against two organisms causing endophthalmitis after IVI. METHODS Minimum inhibitory concentration values of topical anesthetics, povidone-iodine, preservative benzalkonium chloride (0.01%), and saline control were determined using five isolates of each Staphylococcus epidermidis and viridans group Streptococcus species (VGS). A broth microdilution technique was used with serial dilutions. RESULTS Lidocaine (8.53 × 10-5mol/mL) had MICs of 4.27 to 8.53 × 10-5 mol/mL, and tetracaine (1.89 × 10-5 mol/mL) had MICs of 9.45 × 10-6 mol/mL for all isolates. Proparacaine (1.7 × 10-5 mol/mL) had MICs of 1.32 to 5.3 × 10-7 and 4.25 × 10-6 mol/mL for S. epidermidis and VGS, respectively). Benzalkonium chloride (3.52 × 10-7 mol/mL) had MICs of 1.86 × 10-9 to 1.1 × 10-8 and 4.40 × 10-8 mol/mL for S. epidermidis and VGS, respectively. Povidone-iodine (1.37 × 10-4 mol/mL) had MICs of 2.14 to 4.28 × 10-6 and 8.56 × 10-6 mol/mL for S. epidermidis and VGS, respectively. CONCLUSION Proparacaine was the anesthetic with the lowest MICs, lower than that of povidone-iodine. Benzalkonium chloride had lower MICs than proparacaine. All tested anesthetics and povidone-iodine inhibited growth of S. epidermidis and VGS at commercially available concentrations. TRANSLATIONAL RELEVANCE For certain patients, it could be possible to use topical anesthetic after povidone-iodine for comfort without inhibiting and perhaps contributing additional antimicrobial benefit.
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Affiliation(s)
| | - Kerryl E Greenwood-Quaintance
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Infectious Disease, Mayo Clinic, Rochester, MN, USA
| | - Robin Patel
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Infectious Disease, Mayo Clinic, Rochester, MN, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA ; Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA ; VRS Foundation Board Member, Mayo Clinic, Rochester, MN, USA
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Benoist d’Azy C, Pereira B, Naughton G, Chiambaretta F, Dutheil F. Antibioprophylaxis in Prevention of Endophthalmitis in Intravitreal Injection: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0156431. [PMID: 27257676 PMCID: PMC4892688 DOI: 10.1371/journal.pone.0156431] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/13/2016] [Indexed: 12/13/2022] Open
Abstract
Despite endophthalmitis being the most feared complication, antibioprophylaxis remains controversial in intravitreal injections. Therefore, we conducted a systematic review and meta-analysis on the effects of antibioprophylaxis in intravitreal injections in the prevention of endophthalmitis. The PubMed, Cochrane Library, Embase and Science Direct databases were searched for studies comparing groups with and without antibiotics in intravitreal injection, with the use of the following keywords: "antibiotic*", "endophthalmitis" and “intravitreal injection*”. To be included, studies needed to specify number of participants and number of endophthalmitis within each group (with and without antibiotics). We conducted meta-analysis on the prevalence of clinical endophthalmitis including both culture-proven and culture negative samples. Nine studies were included. A total of 88 incidences of endophthalmitis were reported from 174,159 injections (0.051% i.e., one incidence of endophthalmitis for 1979 injections). Specifically, 59 incidences of endophthalmitis were reported from 113,530 injections in the group with antibiotics (0.052% or one incidence of endophthalmitis for 1924 injections) and 29 incidences of endophthalmitis from 60,633 injections in the group without antibiotics (0.048% or one endophthalmitis for 2091 injections). Our meta-analysis did not report a significant difference in the prevalence of clinical endophthalimitis between the two groups with and without topical antibiotics: the odds ratio of clinical endophthalimitis was 0.804 (CI95% 0.384–1.682, p = 0.56) for the antibiotic group compared with the group without antibiotics. In conclusion, we performed the first large meta-analysis demonstrating that antibioprophylaxis is not required in intravitreal injections. Strict rules of asepsis remain the only evidence-based prophylaxis of endophthalmitis. The results support initiatives to reduce the global threat of resistance to antibiotics.
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Affiliation(s)
- Cédric Benoist d’Azy
- University Hospital of Clermont-Ferrand (CHU), Ophthalmology, Clermont-Ferrand, France
- University Hospital of Clermont-Ferrand (CHU), Preventive and Occupational Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand (CHU), Clinical Research Direction, Clermont-Ferrand, France
| | - Geraldine Naughton
- Australian Catholic University, Faculty of Health, Melbourne, Victoria, Australia
| | - Frédéric Chiambaretta
- University Hospital of Clermont-Ferrand (CHU), Ophthalmology, Clermont-Ferrand, France
| | - Frédéric Dutheil
- University Hospital of Clermont-Ferrand (CHU), Preventive and Occupational Medicine, Clermont-Ferrand, France
- Australian Catholic University, Faculty of Health, Melbourne, Victoria, Australia
- Clermont Auvergne University, Blaise Pascal University, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions EA3533, Clermont-Ferrand, France
- Research Centre in Human Nutrition (CRNH) Auvergne, Clermont-Ferrand, France
- CNRS, UMR 6024, Physiological and Psychosocial Stress, LAPSCO, University Clermont Auvergne, Clermont-Ferrand, France
- * E-mail:
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23
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Retraction notice to: Endophthalmitis Occurring after Cataract Surgery. Ophthalmology 2016; 123:295-301. [DOI: 10.1016/j.ophtha.2015.08.023] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 11/20/2022] Open
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eliminating antibiotic prophylaxis for intravitreal injections: a consecutive series of 18,839 injections by a single surgeon. Retina 2015; 35:783-8. [PMID: 25526099 DOI: 10.1097/iae.0000000000000392] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE By optimizing the protocol for intravitreal injections, the risk of endophthalmitis can be minimized. This study assesses the incidence of endophthalmitis and other complications after a consecutive series of intravitreal injections where all antibiotics were excluded. METHODS Injections were performed from August 1, 1997 to October 31, 2012 in outpatient examination rooms at the Retina Center of Minnesota by a single retinal surgeon, the lead author. Most injections were performed to treat exudative age-related macular degeneration. Other reasons included diabetic macular edema, cystoid macular edema because of retinal vein occlusions, cytomegalovirus retinitis, and severe uveitis. Injections were given with topical povidone-iodine, proparacaine, and tetracaine, a sterile eyelid speculum, and clean nonsterile gloves, but without any antibiotics. Data were retrospectively analyzed using billing codes from a computer database system. RESULTS A total of 18,839 injections were given. Of these, the following injections were administered: bevacizumab, 15,479 (82.16%); ranibizumab, 1,669 (8.86%); triamcinolone acetonide (Kenalog-40), 1,014 (5.38%); pegaptanib sodium, 370 (1.96%); aflibercept, 148 (0.79%); dexamethasone implant, 88 (0.47%); triamcinolone acetonide (Triesence), 32 (0.17%); dexamethasone, 29 (0.15%); and ganciclovir, 10 (0.05%). There was one case of postinjection endophthalmitis. The incidence of endophthalmitis per injection was 0.0053%. CONCLUSION A low incidence of endophthalmitis can be achieved when topical antibiotics are omitted.
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Pettey JH, Mifflin MD, Olson RJ. Study of the Acute Effects of Povidone-Iodine on Conjunctival Bacterial Flora. J Ocul Pharmacol Ther 2015; 31:627-30. [PMID: 26287981 DOI: 10.1089/jop.2015.0079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The purpose of this laboratory study was to assess the effect of povidone-iodine (PI) use topically on the conjunctiva in regard to needle bore contamination and to compare these results with our previous findings from an evaluation of bacterial contamination following gatifloxacin and moxifloxacin administration. METHODS We performed 100 conjunctival 27-gauge needle penetrations of both eyes of 13 fresh cadavers. Eyes were then soaked in 10% PI, after which conjunctiva was again penetrated 100 times. After conjunctival penetration, the needles were irrigated, and the irrigant was assessed for bacterial growth. Results were compared with previous work assessing fluoroquinolone effectiveness through the same model. RESULTS We observed a 28% (P = 0.003) decrease in bacterial growth and 40% (P < 0.0001) decrease in colony counts after PI placement. Differences between the effect of PI versus moxifloxacin and gatifloxacin were not statistically significant. CONCLUSIONS There is a greater decrease in bacterial load after treatment with PI for surface cultures than for cultures obtained through a needle bore passed through the conjunctiva. PI is a superior approach to topical antibiotics to decrease conjunctival bacterial load.
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Affiliation(s)
- Jeff H Pettey
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
| | - Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
| | - Randall J Olson
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah , Salt Lake City, Utah
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Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review. Int J Retina Vitreous 2015; 1:9. [PMID: 27847602 PMCID: PMC5088471 DOI: 10.1186/s40942-015-0010-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/30/2015] [Indexed: 02/03/2023] Open
Abstract
The purpose of this review is to report and summarize previously reported studies and assess many of the individual steps of the intravitreal injection procedure's possible effect on the prevention of endophthalmitis. The pooled endophthalmitis rate from 20 large retrospective case series of anti-VEGF injections was 144/510,396 (0.028%; 1/3,544). Injections may be performed in an office-based location or in an operating room (OR) and low rates of endophthalmitis can be achieved in either location with careful attention to asepsis. Pre- or post-injection topical antibiotics have not been shown to be effective, and could select for more virulent microorganisms. Povidone-iodine prior to injection is accepted as the gold-standard antiseptic agent, but aqueous chlorhexidine may be an alternative. Antisepsis before and after gel or subconjunctival anesthetic is suggested. The preponderance of Streptococcal infections after intravitreal injection is discussed, including the possible role of aerosolization, which can be minimized by using face masks or maintaining silence. As with other invasive procedures in medicine, the use of sterile gloves, following adequate hand antisepsis, may be considered. Control of the eyelashes and lid margin is required to avoid contamination of the needle, but this can be achieved with or without a speculum. Techniques to minimize vitreous reflux have not been shown to reduce the risk of endophthalmitis. Same day bilateral injections should be performed as two separate procedures, preferably using drug from different lots, especially when using compounded drugs.
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Affiliation(s)
- Rohan Merani
- Retina Associates, Level 4, 8 Thomas St, Chatswood, NSW 2067 Australia
- Save Sight Institute, University of Sydney, Sydney, NSW Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW Australia
- Concord Repatriation General Hospital, Concord, NSW Australia
| | - Alex P Hunyor
- Retina Associates, Level 4, 8 Thomas St, Chatswood, NSW 2067 Australia
- Save Sight Institute, University of Sydney, Sydney, NSW Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW Australia
- Sydney Eye Hospital, Sydney, NSW Australia
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Abstract
Intravitreal injections for the treatment of retinal disorders and intraocular infection have become a common ophthalmic procedure, and injections of anti-vascular endothelial growth factor agents or steroids are frequently performed for the treatment of diabetic macular edema or other diabetic vascular pathology. Diabetic patients may be at higher risk of adverse events than non-diabetic individuals given frequent systemic co-morbidities, such as cardiovascular and renal disease, susceptibility to infection, and unique ocular pathology that includes fibrovascular proliferation. Fortunately, many associated complications, including endophthalmitis, are related to the injection procedure and can therefore be circumvented by careful attention to injection techniques. This review highlights the safety profile of intravitreal injections in patients with diabetes. Although diabetic patients may theoretically be at higher risk than non-diabetic patients for complications, a comprehensive review of the literature does not demonstrate substantial increased risk of intravitreal injections in patients with diabetes.
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Affiliation(s)
- Hasanain Shikari
- Beetham Eye Institute, Joslin Diabetes Center , Boston, Massachusetts , USA and
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Meredith TA, McCannel CA, Barr C, Doft BH, Peskin E, Maguire MG, Martin DF, Prenner JL. Postinjection endophthalmitis in the comparison of age-related macular degeneration treatments trials (CATT). Ophthalmology 2015; 122:817-21. [PMID: 25600198 DOI: 10.1016/j.ophtha.2014.10.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-vascular endothelial growth factor agents in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and to assess the effect of prophylactic topical antimicrobials on incidence. DESIGN Cohort study within a randomized clinical trial. PARTICIPANTS Patients enrolled in CATT. METHODS Patients with neovascular age-related macular degeneration received intravitreal injections of ranibizumab or bevacizumab under 1 of 3 dosing regimens. The study protocol specified preinjection preparation to include use of a sterile lid speculum and povidone iodine (5%). Use of preinjection and postinjection antibiotics was at the discretion of the treating ophthalmologist. Patients were followed up monthly for 2 years. MAIN OUTCOME MEASURES Development of endophthalmitis and visual acuity. RESULTS Endophthalmitis developed after 11 of 18 509 injections (1 per 1700 [0.06%]; 95% confidence interval, 0.03%-0.11%), and in 11 of 1185 patients (0.93%; 95% confidence interval, 0.52-1.66). Incidence of endophthalmitis was 0.15% among injections with no antibiotic use, 0.08% among injections with preinjection antibiotics only, 0.06% among injections with postinjection antibiotics only, and 0.04% among injections with preinjection and postinjection antibiotics (P = 0.20). All eyes were treated with intravitreal antibiotics and 4 underwent vitrectomy. Among the 11 affected eyes, the final study visual acuity was 20/40 or better in 4 eyes (36%), 20/50 to 20/80 in 2 eyes (18%), 20/100 to 20/160 in 3 eyes (27%), and worse than 20/800 in 2 eyes (18%). The final visual acuity was within 2 lines of the visual acuity before endophthalmitis in 5 eyes (45%). CONCLUSIONS Rates of endophthalmitis were low and similar to those in other large-scale studies. Use of topical antibiotics either before or after injection does not seem to reduce the risk for endophthalmitis.
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Affiliation(s)
- Travis A Meredith
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | - Colin A McCannel
- Department of Ophthalmology, University of California, Los Angeles, California
| | - Charles Barr
- Department of Ophthalmology, University of Louisville, Louisville, Kentucky
| | | | - Ellen Peskin
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Rahman N, Murphy CC. Impact of intracameral cefuroxime on the incidence of postoperative endophthalmitis following cataract surgery in Ireland. Ir J Med Sci 2014; 184:395-8. [PMID: 24846749 DOI: 10.1007/s11845-014-1127-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/25/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postoperative endophthalmitis (PE) is a rare complication of cataract surgery, but carries a significant risk of blindness. The European Society of Cataract and Refractive Surgeons published a landmark study in 2007 that revealed the use of intracameral cefuroxime as prophylaxis against endophthalmitis reduced its incidence by fivefold. Since the publication of these results, the use of intracameral cefuroxime in cataract surgery has become a standard practice in many institutions, including our own. AIM To identify the incidence rate of PE among patients undergoing cataract surgery over the 4-year period following the introduction of prophylactic intracameral cefuroxime for cataract surgery. METHODS A retrospective case note review of all cases of postoperative endophthalmitis that occurred between 2007 and 2011 was performed. Our results were compared with an earlier report on PE incidence rates from our institution that was conducted prior to the introduction of intracameral cefuroxime and published in 2001. RESULTS There were five reported cases of endophthalmitis from 2007 to 2011 from a total of 8,239 cataract procedures, giving an incidence rate of 0.06%. This compares with an incidence rate of 0.49% in the earlier study prior to the introduction of intracameral cefuroxime and represents an eightfold reduction in the incidence of PE at our hospital. Of the five cases, three were confirmed on culture and sensitivity (two of which were due to Coagulase negative staphylococci and one due to Pseudomonas aeruginosa). CONCLUSION The incidence of postoperative endophthalmitis has reduced by approximately eightfold since the introduction of intracameral cefuroxime following cataract surgery at our hospital in 2007. This study strongly supports the use of intracameral cefuroxime as prophylaxis against endophthalmitis in all cataract surgical cases.
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Affiliation(s)
- N Rahman
- Department of Ophthalmology, Royal College of Surgeons in Ireland, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, Ireland,
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Fernández-Rubio ME, Cuesta-Rodríguez T, Urcelay-Segura JL, Cortés-Valdés C. [Spectrum and susceptibility of preoperative conjunctival bacteria]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2013; 88:458-465. [PMID: 24257255 DOI: 10.1016/j.oftal.2013.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/07/2013] [Accepted: 06/11/2013] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. METHODS A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. RESULTS A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, β-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. CONCLUSIONS None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers.
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Affiliation(s)
- M E Fernández-Rubio
- Departamento de Oftalmología, Instituto Oftálmico, Laboratorio de Análisis Clínicos, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Abstract
PURPOSE 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Friling E, Lundström M, Stenevi U, Montan P. Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg 2013; 39:15-21. [PMID: 23245359 DOI: 10.1016/j.jcrs.2012.10.037] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To report the nationwide incidence and risk factors for endophthalmitis after cataract surgery in Sweden. SETTING Swedish National Cataract Register containing reports on cataract operations from all Swedish ophthalmic surgical units. DESIGN Prospective epidemiologic study. METHODS Endophthalmitis case reports were collected from 2005 through 2010. Case and control parameters pertaining to patient characteristics and surgical technique were generated from the database. In addition, information from annual surveys regarding the topical prophylactic protocol was analyzed. RESULTS The reports showed 135 endophthalmitis cases in 464,996 operations, equaling an incidence of 0.029%. Patient age over 85 years, perioperative communication with the vitreous and, above all, nonuse of intracameral cefuroxime showed a statistically significant association with endophthalmitis in the logistic regression. Short-term topical antibiotics given as add-on prophylaxis to the intracameral regimen before, after, or before and after the operation did not confer a clear-cut benefit. Groups with topical treatment were small, comprising 14% of the sample. CONCLUSIONS The incidence of endophthalmitis after cataract surgery in Sweden is declining, which appears to be explained by a fall in the frequency of major risk factors. Operating earlier in the cataract course, avoiding capsule breakage, and giving intracameral antibiotics universally should further reduce the endophthalmitis rate.
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Affiliation(s)
- Emma Friling
- From St. Erik Eye Hospital (Friling, Montan), Stockholm, the Department of Clinical Sciences, Ophthalmology (Lundström), Faculty of Medicine, Lund University, Lund, and Sahlgrenska University Hospital (Stenevi), Molndal, Sweden
| | - Mats Lundström
- From St. Erik Eye Hospital (Friling, Montan), Stockholm, the Department of Clinical Sciences, Ophthalmology (Lundström), Faculty of Medicine, Lund University, Lund, and Sahlgrenska University Hospital (Stenevi), Molndal, Sweden
| | - Ulf Stenevi
- From St. Erik Eye Hospital (Friling, Montan), Stockholm, the Department of Clinical Sciences, Ophthalmology (Lundström), Faculty of Medicine, Lund University, Lund, and Sahlgrenska University Hospital (Stenevi), Molndal, Sweden
| | - Per Montan
- From St. Erik Eye Hospital (Friling, Montan), Stockholm, the Department of Clinical Sciences, Ophthalmology (Lundström), Faculty of Medicine, Lund University, Lund, and Sahlgrenska University Hospital (Stenevi), Molndal, Sweden.
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Role of topical, subconjunctival, intracameral, and irrigative antibiotics in cataract surgery. Curr Opin Ophthalmol 2013; 24:60-5. [PMID: 23080014 DOI: 10.1097/icu.0b013e32835a93be] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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Abstract
PURPOSE To evaluate the effect on conjunctival micro-organisms of chlorhexidine alcohol 0.5% eyelid wash in cataract patients. METHODS In this single-centre experimental study, 120 patients scheduled to undergo cataract operation were cultured in the conjunctiva before the operation and after the insertion of the intraocular lens. Bacterial samples for aerobic and anaerobic cultures were taken with a polyvinyl alcohol pad and transported in peptone water to the microbiological laboratory where they were analysed in a blinded fashion. Half of the patients received a standardized eyelid scrub with chlorhexidine alcohol 0.5%, while the rest did not. The conjunctiva of all patients was rinsed preoperatively with chlorhexidine solution 0.05%. RESULTS In all the between-group comparisons, the treated eyelid group had slightly lower bacterial counts than the control group on the postoperative samples, but differences were far from statistically significant. Within-group comparisons revealed statistically significant reduction in colonies and species between the preoperative and postoperative sampling. CONCLUSION In this experimental culture study, no evidence was found to suggest that preoperative eyelid chlorhexidine alcohol wash is effective in further reducing bacterial counts in the conjunctiva when the conjunctiva itself is rinsed preoperatively with chlorhexidine solution. The present results, however, do not contradict that the wash may be of some marginal help in reducing bacterial contamination of the operation field. Consequently, this part of the prophylactic protocol is still in practice in our institution.
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Affiliation(s)
- Talal Ali
- Department of Ophthalmology St Erik Eye Hospital, Karolinska University Laboratory Stockholm, Stockholm, Sweden
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Choi S, Lee HJ, Cheong Y, Shin JH, Jin KH, Park HK, Park YG. AFM study for morphological characteristics and biomechanical properties of human cataract anterior lens capsules. SCANNING 2012; 34:247-56. [PMID: 22331648 DOI: 10.1002/sca.21001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/13/2011] [Indexed: 05/20/2023]
Abstract
The aim of this study was to quantitatively investigate the morphologies (surface roughness) and biomechanical properties (Young's modulus) of human anterior lens capsules (ALCs) for noncataract and cataract groups using atomic force microscopy. Eight human ALCs obtained during phacoemulsification from patients with senile cataracts (72 ± 13 years) were investigated in both the hydrated and dehydrated conditions. The cataract group showed clearly the proliferated lens epithelial cells (LECs) with a monomorphic cell structure, a diameter of 12.54 ± 4.31 μm, and a height of 0.23 ± 0.04 μm, whereas the control group showed no LECs. A substantial amount of false-positive calcification was observed caused by the deposition of remnants of dried salt solution. Cataract group showed significantly higher surface roughness (382.06 nm, p ≤ 0.001) than control group in the anterior side of ALCs, whereas cataract group showed significantly lower surface roughness (353.79 nm, p ≤ 0.001) than control group in their posterior side. Cataract group showed significantly higher Young's modulus (69.52 kPa, p ≤ 0.001) compared to the control group, regardless of the ALC side. Therefore, it is significant that this study provides a new method to examine the nanostructural characteristic and biomechanical property of human ALCs through a nanometer-scale resolution microscopy technique.
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Affiliation(s)
- Samjin Choi
- Department of Biomedical Engineering and Healthcare Industry Research Institute, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Effectiveness of 1.25 % povidone–iodine combined with topical levofloxacin against conjunctival flora in intravitreal injection. Jpn J Ophthalmol 2012; 56:497-501. [DOI: 10.1007/s10384-012-0160-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
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Pathengay A, Khera M, Das T, Sharma S, Miller D, Flynn HW. Acute Postoperative Endophthalmitis Following Cataract Surgery: A Review. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:35-42. [PMID: 26107016 DOI: 10.1097/apo.0b013e31823e574b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Endophthalmitis following cataract surgery is rare but continues to be a serious complication following cataract surgery. Over the years, the incidence of endophthalmitis has declined because of various preoperative and perioperative measures. They include use of antiseptic and appropriate surgical draping techniques. In this review, we have focused on the incidence, existing risk factors, various clinical features, management strategies, and prophylaxis pertaining to postoperative endophthalmitis following cataract surgery. Outcomes and pitfalls of 2 landmark studies, namely, the Endophthalmitis Vitrectomy Study and the European Society of Cataract and Refractive Surgeons Endophthalmitis Study, are briefly mentioned.Infectious endophthalmitis following cataract surgery is a dreaded complication. Preoperative identification of risk factors and effective prophylaxis could help in reducing its incidence. Early diagnosis followed by management of these patients either with vitreous tap or vitrectomy coupled with intravitreal antibiotics holds the key.
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Affiliation(s)
- Avinash Pathengay
- From the *Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL; †Department of Retina and Vitreous Surgery, L V Prasad Eye Institute, GMRV Campus, Visakhapatnam, Andhra Pradesh; and Department of ‡Retina and Vitreous and §Ocular Microbiology Laboratory, L. V. Prasad Eye Institute, Bhubaneswar, Orissa, India
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Abstract
As the intravitreal injection of therapeutic medication plays an increasingly large role in ophthalmology, its implementation continues to be modified and refined. Variations in injection technique are discussed, and the authors combine their clinical and research experience with a review of the literature to propose a recommended intravitreal injection protocol.
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Affiliation(s)
- Rishi R Doshi
- California Pacific Medical Center, Department of Ophthalmology, San Francisco, CA 94115, USA
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Fernandes M, Pathengay A. Reduction of anterior chamber contamination rate after cataract surgery by intraoperative surface irrigation with 0.25% povidone-iodine. Am J Ophthalmol 2011; 152:320; author reply 320-1. [PMID: 21784194 DOI: 10.1016/j.ajo.2011.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/16/2011] [Indexed: 10/17/2022]
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Lindquist TD, Maxwell AJ, Miller TD, Win'E TL, Novicki T, Fritsche TR, Iliakis B, Montoya M. Preparation of Corneal Donor Eyes Comparing 1% Versus 5% Povidone–Iodine. Cornea 2011; 30:333-7. [DOI: 10.1097/ico.0b013e3181eeb5d2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yiu G, Young L, Gilmore M, Chodosh J. Prophylaxis against postoperative endophthalmitis in cataract surgery. Int Ophthalmol Clin 2011; 51:67-83. [PMID: 21897141 DOI: 10.1097/iio.0b013e31822d6b3d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Glenn Yiu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Penetrating Keratoplasty. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Olson R, Donnenfeld E, Bucci FA, Price FW, Raizman M, Solomon K, Devgan U, Trattler W, Dell S, Wallace RB, Callegan M, Brown H, McDonnell PJ, Conway T, Schiffman RM, Hollander DA. Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery. Clin Ophthalmol 2010; 4:1505-14. [PMID: 21191448 PMCID: PMC3009999 DOI: 10.2147/opth.s14333] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose: The purpose of this study is to characterize the bacterial flora of the ocular and periocular surface in cataract surgery patients and to determine the prevalence of methicillin resistance among staphylococcal isolates obtained from health care workers (HCWs) and non-HCWs. Methods: In this prospective, multicenter, case series study, eyelid and conjunctival cultures were obtained from the nonoperative eye of 399 consecutive cataract patients on the day of surgery prior to application of topical anesthetics, antibiotics, or antiseptics. Speciation and susceptibility testing were performed at the Dean A. McGee Eye Institute. Logistic regression was utilized to evaluate whether any factors were significant in predicting the presence of methicillin-resistant staphylococcal isolates. Results: Staphylococcus epidermidis (62.9%), followed by S. aureus (14.0%), was the most frequently isolated organism. Methicillin-resistant S. epidermidis accounted for 47.1% (178/378) of S. epidermidis isolates, and methicillin-resistant S. aureus accounted for 29.5% (26/88) of S. aureus isolates. Methicillin-resistant staphylococcal isolates were found in 157 of 399 (39.3%) patients, the majority (89.2%) of whom were non-HCWs. The likelihood of being colonized with methicillin-resistant organisms increased with age (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.02–1.58; P = 0.04) but decreased with diabetes (OR, 0.51; 95% CI: 0.29–0.89; P = 0.02). Being a HCW (OR, 1.25; 95% CI: 0.61–2.58; P = 0.54) was not a risk factor for colonization with methicillin-resistant organisms. Conclusion: Patients without exposure to health care environments are as likely as HCWs to be colonized with methicillin-resistant organisms. Increasing methicillin resistance with age may partially explain the increased risk of endophthalmitis reported with older age.
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Affiliation(s)
- Randall Olson
- The John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA.
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Abstract
PURPOSE OF REVIEW Over the past few years, the results of many studies have highlighted the risks and benefits of intravitreal injection of a number of medications, the most common being triamcinolone, antivascular endothelial growth factor (VEGF) agents, antibiotics, antivirals, antifungals, and methotrexate. The purpose of this review is to highlight the complications associated with these injections. RECENT FINDINGS Elevated intraocular pressure and glaucoma are the most common complications of intraocular triamcinolone. There is also an increased incidence of cataract formation/progression over time. The immunosuppressive effect of triamcinolone does not appear to increase the risk of endophthalmitis. Recent reports suggest that intravitreal anti-VEGF injections have a low complication rate. Similarly, antimicrobials also have low rates of injection-associated complications. SUMMARY Intravitreal injections play a critical role in daily ophthalmic practice. The overall risk of endophthalmitis and retinal detachment appears to be low and most of the commonly used drugs are well tolerated, even with repeat injection. Further long-term studies need to be performed to elucidate ways of increasing the safety of these procedures and medications.
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Bhavsar AR, Googe JM, Stockdale CR, Bressler NM, Brucker AJ, Elman MJ, Glassman AR. Risk of endophthalmitis after intravitreal drug injection when topical antibiotics are not required: the diabetic retinopathy clinical research network laser-ranibizumab-triamcinolone clinical trials. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2009; 127:1581-3. [PMID: 20008710 PMCID: PMC2874253 DOI: 10.1001/archophthalmol.2009.304] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Halachimi-Eyal O, Lang Y, Keness Y, Miron D. Preoperative topical moxifloxacin 0.5% and povidone–iodine 5.0% versus povidone–iodine 5.0% alone to reduce bacterial colonization in the conjunctival sac. J Cataract Refract Surg 2009; 35:2109-14. [DOI: 10.1016/j.jcrs.2009.06.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/28/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
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He L, Ta CN, Hu N, Sinnar S, Miño de Kaspar H. Prospective randomized comparison of 1-day and 3-day application of topical 0.5% moxifloxacin in eliminating preoperative conjunctival bacteria. J Ocul Pharmacol Ther 2009; 25:373-8. [PMID: 19492956 DOI: 10.1089/jop.2008.0102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Compare the efficacy of a 1-day versus 3-day application of topical 0.5% moxifloxacin in reducing preoperative conjunctival bacteria. METHODS Following IRB approval, patients (n = 144) scheduled for ocular surgery between 2004 and 2005 were recruited and randomized to receive topical 0.5% moxifloxacin drops four times a day for either 1 day (n = 63) or 3 days (n = 57) prior to surgery. Conjunctival cultures were obtained at baseline (T0), after application of antibiotic (T1), following povidone-iodine and additional antibiotic applications immediately before surgery (T2), and after surgery (T3). Cultures were inoculated onto blood and chocolate agar plates and in thioglycolate broth, and then incubated at 37 degrees C for 10 days. Bacterial growth were isolated, identified, quantified, and compared. RESULTS There were similar (P = 0.8435) rates of patients with positive thioglycolate cultures between the 1-day (79.37%) and 3-day groups (82.46%) at T0. At T1, T2, and T3, the number of eyes with positive cultures were again similar (1 day, 3 days, P value [T1: 34.9%, 35.1%, P = 0.8631; T2: 14.3%, 7%, P = 0.3245; T3: 7.9%, 3.5%, P = 0.5199]). No significant differences were found between the colony-forming units (CFU) of bacteria on solid agar media in 1-day and 3-day groups at any of the time points studied (P values: 0.1-0.8). Coagulase-negative Staphylococcus was the most commonly isolated (73.3% at baseline). CONCLUSIONS In patients undergoing intraocular anterior segment surgery, 1-day and 3-day applications of topical 0.5% moxifloxacin appear to have similar efficacy in reducing perioperative conjunctival bacteria.
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Affiliation(s)
- Lingmin He
- Department of Ophthalmology, School of Medicine, Stanford University, 900 Blake Wilbur Drive, Stanford, CA 94304, USA
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Abstract
BACKGROUND Intravitreal injection (IVI) with administration of various pharmacological agents is a mainstay of treatment in ophthalmology for endopthalmitis, viral retinitis, age-related macular degeneration, cystoid macular edema, diabetic retinopathy, uveitis, vascular occlusions, and retinal detachment. The indications and therapeutic agents are reviewed in this study. METHODS A search of the English, German, and Spanish language MEDLINE database was conducted. A total of 654 references spanning the period through early 2008 were individually evaluated. RESULTS The advantage of the IVI technique is the ability to maximize intraocular levels of medications and to avoid the toxicities associated with systemic treatment. Intravitreal injection has been used to deliver several types of pharmacological agents into the vitreous cavity: antiinfective and antiinflammatory medications, immunomodulators, anticancer agents, gas, antivascular endothelial growth factor, and several others. The goal of this review is to provide a detailed description of the properties of numerous therapeutic agents that can be delivered through IVI, potential complications of the technique, and recommendations to avoid side effects. CONCLUSION The IVI technique is a valuable tool that can be tailored to the disease process of interest based on the pharmacological agent selected. This review provides the reader with a comprehensive summary of the IVI technique and its multitude of uses.
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Affiliation(s)
- Gholam A Peyman
- Department of Ophthalmology and Vision Science, College of Medicine, University of Arizona, Tucson, Arizona 85351, USA.
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Flynn HW, Pflugfelder SC, Culbertson WW, Davis JL. Recognition, Treatment, and Prevention of Endophthalmitis: Appendix. Semin Ophthalmol 2009. [DOI: 10.3109/08820538909060138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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