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Romano V, Ferrara M, Gatti F, Airaldi M, Borroni D, Aragona E, Rocha-de-Lossada C, Gabrielli F, Papa FT, Romano MR, Calza S, Semeraro F. Topical Antiseptics in Minimizing Ocular Surface Bacterial Load Before Ophthalmic Surgery: A Randomized Controlled Trial. Am J Ophthalmol 2024; 261:165-175. [PMID: 38211781 DOI: 10.1016/j.ajo.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
PURPOSE To investigate the reduction of the ocular surface bacterial load induced by 2 commercially available ophthalmic antiseptic formulations, povidone-iodine (PVI) 0.6% and chlorhexidine (CLX) 0.02%, before ocular surgery. DESIGN Randomized controlled trial. METHODS Seventy adult patients undergoing intraocular surgery (phacoemulsification) were randomized to receive in the index eye PVI (group A) 4 times a day for 3 days or CLX (group B) 4 times a day for 3 days before surgery. The untreated eye was used as control. A conjunctival swab was taken in both eyes before (T0) and after (T1) therapy. Microbial DNA was quantified with real-time polymerase chain reaction (PCR) analysis. The Mick algorithm was used to compare the abundance of each genus/genera against the distribution of abundances from the reference. At T1, patients filled a questionnaire to evaluate therapy-induced symptoms. Primary outcome was the reduction of bacterial DNA at T1 (microbial load), vs control arm, expressed as mean number of real-time PCR cycle times (CTs). Secondary outcomes were taxonomic composition, differential abundance, and therapy-induced ocular symptoms. RESULTS The T0-T1 difference in CT was significant in group B, but not in group A (mean [95% CI], 0.99 [0.33] vs 0.26 [0.15], P < .001, and 0.65 [0.3] vs 0.45 [0.41], P = .09, respectively). The taxonomic composition, alpha, and beta diversity remained consistent at all time points in both groups. The rate of patients reporting therapy-induced ocular symptoms and the mean discomfort grade were greater in group A than in group B (97% vs 26% and 4.97±2.48 vs 0.66±1.53, respectively). CONCLUSIONS Compared with PVI 0.6%, CLX 0.02% induced a greater reduction of ocular surface bacterial load, with no significant alterations of the taxonomic composition. Moreover, CLX was better tolerated than PVI.
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Affiliation(s)
- Vito Romano
- From the Eye Unit, ASST Spedali Civili di Brescia (V.R., F.S.), Brescia, Italy; Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia (V.R., Fr.G., F.S.), Brescia, Italy
| | | | - Francesca Gatti
- Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia (V.R., Fr.G., F.S.), Brescia, Italy
| | - Matteo Airaldi
- Department of Molecular and Translational Medicine, Università degli Studi di Brescia (M.A.), Brescia, Italy; St. Paul's Eye Unit, Royal Liverpool University Hospital (M.A.), Liverpool, United Kingdom
| | - Davide Borroni
- Eyemetagenomics Ltd, Covent Garden (D.B., C.R.-d.-l.), London, United Kingdom
| | - Emanuela Aragona
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute (E.A.), Milan, Italy
| | - Carlos Rocha-de-Lossada
- Eyemetagenomics Ltd, Covent Garden (D.B., C.R.-d.-l.), London, United Kingdom; Ophthalmology Department, QVision, Vithas Almería (C.R.-d.-l.), Almeria, Spain; Ophthalmology Department, Hospital Regional Universitario Málaga (C.R.-d.-l.), Malaga, Spain
| | - Federico Gabrielli
- Biolab SRL, Laboratorio di Genetica e Genomica Molecolare (Fe.G., F.T.P.), Ascoli Piceno, Italy
| | - Filomena Tiziana Papa
- Biolab SRL, Laboratorio di Genetica e Genomica Molecolare (Fe.G., F.T.P.), Ascoli Piceno, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University (M.R.R.), Milan, Italy; Department of Ophthalmology, Humanitas Gavazzeni-Castelli (M.R.R.), Bergamo, Italy
| | - Stefano Calza
- Unit of Biostatistics and Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia (S.C.), Brescia, Italy
| | - Francesco Semeraro
- From the Eye Unit, ASST Spedali Civili di Brescia (V.R., F.S.), Brescia, Italy; Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia (V.R., Fr.G., F.S.), Brescia, Italy
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Ferrara M, Gatti F, Lockington D, Iaria A, Kaye S, Virgili G, Aragona P, Semeraro F, Romano V. Antimicrobials and antiseptics: Lowering effect on ocular surface bacterial flora - A systematic review. Acta Ophthalmol 2024; 102:e215-e228. [PMID: 37427851 DOI: 10.1111/aos.15732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/12/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023]
Abstract
Topical antimicrobials and antiseptics are used perioperatively to reduce the ocular surface bacteria flora (OSBF) that are involved in the development of post-operative infectious complications. However, their effectiveness is still a controversial topic. This systematic review, performed according to the PRISMA guidelines and registered in PROSPERO, aims to provide an overview of the efficacy of the agents currently used in peri-cataract surgery and -intravitreal injections (IVI) in lowering the OSBF. Although effective in lowering OSBF, perioperative topical antimicrobials are associated with the risk of resistance development, with no obvious additional benefit compared with topical antisepsis. Conversely, the effectiveness of topical antiseptics before cataract surgery and IVI is strongly supported. Based on the available evidence, perioperative antimicrobials are not recommended, whereas the perioperative use of antiseptics is strongly recommended as prophylactic treatment for lowering the infection due to OSBF. Post-operative antimicrobials may be considered in eyes at higher risk for infection.
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Affiliation(s)
| | - Francesca Gatti
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Antonio Iaria
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
| | - Stephen Kaye
- St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool, UK
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Gianni Virgili
- Eye Clinic, AOU Careggi Teaching Hospital, University of Florence, Florence, Italy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Pasquale Aragona
- Department of Biomedical Sciences, University of Messina, Messina, Italy
| | - Francesco Semeraro
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
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Azzaro C, Meduri A, Oliverio GW, De Luca L, Gazia F, Franchina F, Aragona P. The Use of Venous Catheter and Irrigation with Povidone-Iodine 0.6% in Patients with Punctal and Proximal Canalicular Stenosis: Preliminary Report. J Clin Med 2024; 13:1330. [PMID: 38592157 PMCID: PMC10932350 DOI: 10.3390/jcm13051330] [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: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This study aimed to evaluate the safety and efficacy of povidone-iodine 0.6% (PVI) irrigation for preventing recurrence of stenosis after punctoplasty in patients with punctal and proximal canalicular stenosis treated using a venous catheter as a stent. Methods: Twenty patients were enrolled and divided into two groups. Group 1 received irrigation of 1 mL 0.6% PVI, while Group 2 received 1 mL of balanced salt solution (BSS). The patients underwent baseline, 15-, 30-, and 90-day assessments using the Ocular Surface Disease Index (OSDI) questionnaire, Symptoms Assessment in Dry Eye (SANDE), Schirmer I test, tear meniscus height (TMH), bulbar redness, meibography, and non-invasive breakup time (NIKBUT) through Keratograph 5M (Oculus, Germany). Results: At three months, both groups demonstrated statistically significant improvements in symptoms and ocular surface parameters. However, Group 1 showed statistically significant improvements in OSDI, SANDE scores, bulbar redness, and NIKBUT compared to Group 2. Additionally, no patients in Group 1 presented a recurrence of stenosis, while three patients in Group 2 demonstrated stenosis relapse at the end of the follow-up period. Conclusions: The application of a venous catheter and PVI 0.6% irrigations proved to be effective in treating proximal lacrimal duct stenosis, reducing the risk of recurrence and improving tear film stability, ocular discomfort symptoms, and ocular surface parameters.
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Affiliation(s)
- Claudia Azzaro
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
| | - Alessandro Meduri
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
| | - Giovanni William Oliverio
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
| | - Laura De Luca
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
| | - Francesco Gazia
- Unit of Otorhinolaryngology, Papardo Hospital, AO Papardo C. da Papardo 1, 98158 Messina, Italy
| | - Francesco Franchina
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
| | - Pasquale Aragona
- Bioscenses Departement, Ophthalmology Clinic, University of Messina, 98124 Messina, Italy; (C.A.); (A.M.); (G.W.O.); (F.F.); (P.A.)
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Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management. Ophthalmol Ther 2023; 12:721-734. [PMID: 36719608 PMCID: PMC10011360 DOI: 10.1007/s40123-023-00661-9] [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: 12/18/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
In this review we discuss the role of intraocular surgery preoperative prophylaxis. The correct choice of antimicrobial drug is variable in each surgical setting, according to the available strengths of evidence, the anatomical district involved, and the type of procedure. In the ophthalmic surgical field, there has been a progressive shift from antibiotic formulations, which are known to cause antibiotic resistance, to a new class of antiseptic compounds, which proved to be effective not only against bacteria, but also against fungi, protozoa, and viruses. Among these, povidone-iodine (PVI) is a water-soluble polymer that can form a complex with iodine, and the perioperative application of PVI 5-10% eye drop for 3 min is the gold standard for infection prophylaxis. A new formulation of 0.6% PVI eye drop is a new option for infection prophylaxis in the days before surgery. Chlorhexidine is a biguanide compound, which is a valid alternative with a good safety and efficacy profile and is the antiseptic of choice in patients with iodine allergy. New compounds that are currently being studied include polyhexamethylene biguanide (PHMB), picloxydine, ozone, hypochlorous acid (HOCl), and Biosecur. PHMB is a biguanide polymer that was found to be more effective than PVI in in vitro studies for reducing microorganisms and extending the duration of antisepsis, but to date, there are no formulations available on the market for preoperative ocular surgery in which it is present as main ingredient. Ozone is a molecule with oxidizing effect, which showed interesting preliminary results but is not effective against virus, Staphylococcus aureus and Candida albicans. HOCl has a natural bactericidal propriety but its applicability to prophylaxis of ocular infection in the setting of ocular surgery is not established. Biosecur is a non-toxic organic alcohol-free compound that exhibited bactericidal and fungicidal effect versus all common microorganisms and is currently available as an ocular spray.
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Jiang X, Wan Y, Yuan H, Zhao L, Sun M, Xu Y, Xin X, Dong J, Hu D, Chen D, Li X. Incidence, Prophylaxis and Prognosis of Acute Postoperative Endophthalmitis After Cataract Surgery: A Multicenter Retrospective Analysis in Northern China from 2013 to 2019. Infect Drug Resist 2022; 15:4047-4058. [PMID: 35924017 PMCID: PMC9342430 DOI: 10.2147/idr.s332997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the incidence of acute postoperative endophthalmitis (POE) after cataract surgery in Northern China from 2013 to 2019, evaluate the efficacy of prophylaxis and analyze the predictors of visual prognosis among POE patients. Methods The study was conducted as a retrospective multi-center research, with seven hospitals in Northern China enrolled. The diagnosis of acute-onset POE was made on the basis of clinical manifestations within six weeks after initial surgery. By reviewing electronic medical system, the number of cataract surgeries and acute POE cases were recorded to estimate the overall incidence and incidences by different years and hospitals. Perioperative measures for preventing infection in different hospitals were collected. The correlations between unfavorable final vision and potential factors including basic information and clinical characteristics were examined to determine the predictive factors for final visual prognosis. Results Of 72,255 cataract surgeries performed during seven years in the seven hospitals, 19 cases developed acute POE, yielding an overall incidence of 0.026%. The average incidence of acute POE among seven hospitals significantly declined annually during the past 7 years (p = 0.021). In Hospital-D, the incidence of acute POE significantly decreased after the application of 0.5% povidone-iodine (PVP-I) for conjunctival washing (p = 0.003). Two hospitals adopting tobramycin in the irrigation solution achieved a significant lower incidence of POE than the other hospitals (p = 0.044). The positive rate of pathogen culture was just 17.6% (3/19). Patients with presenting BCVA of CF or better were more likely to present with unfavorable final vision than those with worse presenting BCVA (p = 0.003). Conclusion The overall incidence of acute POE after cataract surgery from 2013 to 2019 in Northern China was 0.026%, and the incidence declined annually over the period. Presenting BCVA could be a significant prognosis factor for predicting the final visual outcomes of acute POE patients.
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Affiliation(s)
- Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Yu Wan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Hao Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Liming Zhao
- Department of Ophthalmology, Beijing Fengtai Hospital, Beijing, People’s Republic of China
| | - Min Sun
- Department of Ophthalmology, Huabei Petroleum General Hospital, Renqiu, Hebei, People’s Republic of China
| | - Yanhui Xu
- Department of Ophthalmology; Hebei Provincial Eye Hospital, Xingtai, Hebei, People’s Republic of China
| | - Xiangyang Xin
- Department of Ophthalmology, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, People’s Republic of China
| | - Jing Dong
- Department of Ophthalmology, the First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, People’s Republic of China
| | - Die Hu
- Department of Ophthalmology, Baoding Zhuozhou GEM Flower Hospital, Zhuozhou, Hebei, People’s Republic of China
| | - Dongmei Chen
- Department of Ophthalmology, Baoding GEM Flower Eastern Hospital, Zhuozhou, Hebei, People’s Republic of China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, People’s Republic of China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, People’s Republic of China
- Correspondence: Xuemin Li, Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People’s Republic of China, Tel +86 10 8226 6312, Fax +86 10 8208 9951, Email
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Comparative Evaluation of Bandage Contact Lenses and Eye Patching after Bilateral Cataract Surgery. J Ophthalmol 2021; 2021:2873543. [PMID: 34422403 PMCID: PMC8378946 DOI: 10.1155/2021/2873543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To comparatively evaluate the safety and satisfaction of bandage contact lens (BCL) and eye patching in patients after cataract surgery. Methods Sixteen (32 eyes) patients who planned to undergo bilateral cataract surgery were recruited. The two eyes of each patient were randomly divided into 2 groups. Group A and Group B were instructed to wear BCLs immediately at the end of the surgery until one week and eye patch immediately after surgery until one day, respectively. Visual analog scales of ten specific symptoms, Visual Function Index (VF-14) questionnaire, and best-corrected visual acuity (BCVA) were conducted on the first day before the surgery and Day 1 and Day 7 after surgery. Oculus keratography was conducted on the first day before surgery and on Day 7. Patient satisfaction was determined on Day 1. Moreover, bacterial species in the conjunctival sac, meibomian gland secretions, and BCLs were subsequently identified using 16S rRNA gene sequencing. Results The patient satisfaction scores of Group A were higher than Group B. Group A were more motivated to choose the same treatment and were more likely to recommend BCLs to others. No statistically significant differences were found in bacterial culture positivity between the groups. The differences in ocular signs and symptoms between the two groups were not statistically significant. There were no significant differences in the BCVA and VF-14 between the groups at any time point. Conclusions BCLs could be safely and effectively used in patients after cataract surgery.
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Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone-Iodine. J Clin Med 2021; 10:jcm10163611. [PMID: 34441906 PMCID: PMC8397035 DOI: 10.3390/jcm10163611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/09/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022] Open
Abstract
Postoperative endophthalmitis after cataract surgery is typically caused by the patient's own conjunctival normal bacterial flora. A three-step approach is recommended to prevent endophthalmitis: (1) "border control" to prevent microorganisms from entering the eye by disinfecting the ocular surface is the most important measure; (2) bacteria that have gained access into the anterior chamber are reduced by irrigation; (3) bacteria remaining in the anterior chamber and vitreous at the end of surgery are controlled by antibacterial drugs. We have devised a method, "the Shimada technique", for irrigating the ocular surface with povidone-iodine, a disinfectant with potent microbicidal effect and established effective and safe concentrations for eye tissues. Povidone-iodine exhibits a bactericidal effect for a wide concentration range of 0.005-10%, but 0.1% povidone-iodine has the highest activity and requires the shortest time of only 15 s to achieve microbicidal effect. When used to irrigate the ocular surface every 20-30 s during cataract surgery, 0.25% povidone-iodine is conceivably diluted to around 0.1%. Irrigation with 0.25% povidone-iodine during cataract surgery significantly reduced bacteria contamination rate in the anterior chamber compared with saline (p = 0.0017) without causing corneal endothelial damage.
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