Ocular surface flora and prophylactic antibiotics for cataract surgery in the age of antimicrobial resistance

Purpose Povidone-iodine (PI) is widely used to reduce the preoperative conjunctival bacterial load. This study aimed to evaluate the employment of PI 10% in an attempt to sterilize the ocular surface prior to cataract surgery, and to show that PI could be left in contact for 3 minutes. The viability of this exposure time in clinical practice, associated adverse events, and visual outcomes were documented. Methods In this prospective cohort study, phacoemulsification cataract surgery was performed in 604 patients by a single surgeon. Preoperative preparation was undertaken with PI 10%, applied to the cornea, conjunctival sac, eyelids, and periorbital skin with sterile cotton gauze. Povidone-iodine was then flushed onto the ocular surface. Operating room staff timed the precise duration of exposure. After the 3-minute preparation, the lids were thoroughly dried with fresh dry gauze. Results The median PI exposure time was 3.17 minutes, with an interquartile range of 0.25. All cases were followed up postoperatively at 1 day, 1 week, and 1 month. There were no complications attributable to PI. Visual outcomes were satisfactory. Conclusions Implementation of a preoperative prophylaxis protocol that used PI 10% with a 3-minute exposure time can be performed in clinical practice. The 3-minute exposure time had no adverse sequelae.

Download Full-text

Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study

Journal of Clinical Medicine ◽

10.3390/jcm10102198 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2198

Author(s):

Rosario Musumeci ◽

Pasquale Troiano ◽

Marianna Martinelli ◽

Matteo Piovella ◽

Claudio Carbonara ◽

...

Keyword(s):

Cataract Surgery ◽

Ocular Surface ◽

Povidone Iodine ◽

Bacterial Species ◽

Bacterial Flora ◽

Bacterial Load ◽

Controlled Study ◽

Eye Drops ◽

Microbiological Analysis ◽

Contralateral Eye

A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery; the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM®) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure.

Download Full-text

Ocular-surface temperature modification by cataract surgery

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2016.04.023 ◽

2016 ◽

Vol 42 (7) ◽

pp. 983-989 ◽

Cited By ~ 7

Author(s):

Giuseppe Giannaccare ◽

Michela Fresina ◽

Luca Agnifili ◽

Piera Versura

Keyword(s):

Surface Temperature ◽

Cataract Surgery ◽

Ocular Surface ◽

Temperature Modification

Download Full-text

Overuse of antibiotics in maternity and neonatal wards, a descriptive report from public hospitals in Dar es Salaam, Tanzania

10.21203/rs.3.rs-200744/v1 ◽

2021 ◽

Author(s):

Mwaka Athuman Kakolwa ◽

Susannah L. Woodd ◽

Alexander M. Aiken ◽

Fatuma Manzi ◽

Giorgia Gon ◽

...

Keyword(s):

Drug Resistance ◽

Antimicrobial Resistance ◽

Antibiotic Use ◽

Dar Es Salaam ◽

Prophylactic Antibiotics ◽

Public Hospitals ◽

Descriptive Data ◽

Inappropriate Use ◽

Control Drug ◽

Postnatal Women

Abstract Background: Overuse of antibiotics is a major challenge and undermines measures to control drug resistance worldwide. Postnatal women and newborns are at risk of infections and are often prescribed prophylactic antibiotics, although there is no evidence to support their universal use in either group. Methods: We performed point prevalence surveys in three hospitals in Dar es Salaam, Tanzania, in 2018 to collect descriptive data on antibiotic use and infections in maternity and neonatal wards. Results: Prescribing of antibiotics was high in all three hospitals ranging from 90% (43/48) to 100% (34/34) in women after cesarean section, from 1.4% (1/73) to 63%(30/48) in women after vaginal delivery, and from 89%(76/85) to 100%(77/77) in neonates. The most common reason for prescribing antibiotics was medical prophylaxis in both maternity and neonatal wards.Conclusion: We observed substantial overuse of antibiotics in postnatal women and newborns.This calls for urgent antibiotic stewardship programs in Tanzanian hospitals to curb the inappropriate use and limit the spread of antimicrobial resistance.

Download Full-text

Reduction of Ocular Surface Damage and Bacterial Survival Using 0.05% Povidone-Iodine Ocular Surface Irrigation before Cataract Surgery

Ophthalmic Research ◽

10.1159/000501373 ◽

2019 ◽

Vol 62 (3) ◽

pp. 166-172 ◽

Cited By ~ 2

Author(s):

Fang Fan ◽

Zhihua Zhao ◽

Xiaobin Zhao ◽

Qingmin Ma ◽

Kejun Li ◽

...

Keyword(s):

Cataract Surgery ◽

Ocular Surface ◽

Povidone Iodine ◽

Surface Damage ◽

Bacterial Survival ◽

Surface Irrigation

Download Full-text

Association among Blink Rate, Changes in Ocular Surface Temperature, Tear Film Stability, and Functional Visual Acuity in Patients after Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2019/8189097 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Takashi Itokawa ◽

Yukinobu Okajima ◽

Takashi Suzuki ◽

Tatsuhiko Kobayashi ◽

Yuto Tei ◽

...

Keyword(s):

Visual Acuity ◽

Regression Analysis ◽

Cataract Surgery ◽

Ocular Surface ◽

Tear Film ◽

Blink Rate ◽

Film Stability ◽

Tear Film Stability ◽

Functional Visual Acuity ◽

Film Group

Purpose. To investigate the association among the ocular surface temperature (OST), tear film stability, functional visual acuity (FVA), and blink rate in patients after cataract surgery. Methods. We recruited 98 eyes of 69 patients (mean age, 73.7 ± 5.2 years) 1 month after phacoemulsification with implantation of acrylic intraocular lenses and assessed slit-lamp microscopy, corrected distance VA, FVA, noninvasive tear breakup time (NIBUT), and OST. We defined the changes in the OST from 0 to 10 seconds after eye opening as the ΔOST. We measured the FVA and blink rate using the FVA measurement system. We divided the patients into two groups based on tear film stability: stable tear film (NIBUT, >5.0 seconds) and unstable tear film (NIBUT, ≤5.0 seconds). We evaluated the differences between the two groups and the association between the blink rate and other clinical parameters. Results. The unstable tear film group (56 eyes) had significantly (p<0.0001, unpaired t-test) shorter NIBUTs than the stable tear film group (42 eyes). The ΔOSTs and blink rates were significantly (p<0.0001) higher in the unstable tear film group than in the stable group. Linear single regression analysis showed that the ΔOST (r = −0.430, p<0.0001), NIBUT (r = −0.392, p<0.0001), and gender (r = −0.370, p=0.0002) were correlated significantly with the blink rate. Multiple regression analysis showed that the ΔOST independently contributed to the blink rate. Conclusions. The frequency of blinks is associated with tear film stability in patients after cataract surgery. The blink rate may be useful for evaluating the tear film stability in clinical practice. The ΔOST should be an important contributing factor to the blink rate. [This trial is registered with UMIN000026970].

Download Full-text