Effect of Topical Moxifloxacin on the Bacterial Flora of the Ocular Surface following Cataract Surgery: A Randomized, Single-Masked Clinical Trial

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.

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Efficacy of 0.05% cyclosporine A on the lipid layer and meibomian glands after cataract surgery: A randomized, double-masked study

PLoS ONE ◽

10.1371/journal.pone.0245329 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245329

Author(s):

Min Seung Kang ◽

Jonghoon Shin ◽

Jeong Min Kwon ◽

Jin Huh ◽

Ji Eun Lee

Keyword(s):

Clinical Trial ◽

Cataract Surgery ◽

Cyclosporine A ◽

Ocular Surface ◽

Lipid Layer ◽

Significant Difference ◽

Group A ◽

Meibomian Glands ◽

Group B

Purpose To quantitatively evaluate the effects of 0.05% cyclosporine A (CsA) on lipid layer thickness (LLT) and meibomian glands after cataract surgery using the LipiView® ocular surface interferometer. Methods This study was a prospective randomized double-masked clinical trial conducted by Pusan National University Yangsan Hospital between April 04, 2019, and November 31, 2019. Sixty-two participants were recruited, and 12 of them were not enrolled because they had undergone previous treatments for ocular surface diseases. The participants were adult patients with cataract, exhibiting normal lid position; they did not present any other ocular disease and did not meet the exclusion criteria of the clinical trial. Fifty subjects were enrolled in the study. The randomized subjects received treatment with 0.05% CsA (group A) or 0.5% carboxymethyl cellulose (CMC) (group B) over the 3 months following the cataract surgery. Subjective and objective assessments were performed at preoperative and postoperative visits. Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), and Schirmer’s I test were performed by the same surgeon, and LLT and meiboscore were determined using the LipiView® interferometer. Results Fifty subjects subjects enrolled consisted of men (50%) and women (50%), with a mean (SD) age of 65.94 (10.35) years. Four subjects in group A and five in group B were excluded from the analysis as they were lost to follow-up within 1 month after cataract surgery. Thus, the study comprised 41 eyes of 41 subjects; 21 subjects were treated with CsA and 20 subjects with CMC. Comparing the clinical measurements between groups A and B taken at the last visit, while controlling the effects of the preoperative values, TBUT and LLT showed significant differences (p = 0.035 and p = 0.047, respectively, by ANCOVA). The TBUT between the subjects using CsA and those using CMC after cataract surgery showed a significant difference during follow up (p = 0.003 by repeated measures ANOVA). In the multivariate analysis, preoperative LLT and the use of CsA were found to be independent parameters for postoperative LLT (R2 = 0.303; p = 0.008 and p = 0.045, respectively), whereas the follow-up duration exhibited a positive correlation with the difference between the preoperative and postoperative values of LLT in the group treated with CsA (R2 = 0.738 and p < 0.001). Conclusion Treatment with 0.05% CsA following cataract surgery is effective in improving TBUT and LLT in comparison with 0.5% CMC. A higher preoperative value of LLT and the postoperative use of CsA could be significant determinants of a higher postoperative LLT value. Trial registration ISRCTN registry with ISRCTN 10173448.

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Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone–Iodine

Journal of Clinical Medicine ◽

10.3390/jcm10163611 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3611

Author(s):

Hiroyuki Shimada ◽

Hiroyuki Nakashizuka

Keyword(s):

Cataract Surgery ◽

Anterior Chamber ◽

Ocular Surface ◽

Povidone Iodine ◽

Bacterial Flora ◽

Bactericidal Effect ◽

Endothelial Damage ◽

Contamination Rate ◽

Eye Tissues ◽

Normal Bacterial Flora

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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Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

European Journal of Ophthalmology ◽

10.5301/ejo.5000964 ◽

2017 ◽

Vol 27 (5) ◽

pp. 573-576 ◽

Cited By ~ 7

Author(s):

Chu L. Nguyen ◽

Lawrence J. Oh ◽

Eugene Wong ◽

Ian C. Francis

Keyword(s):

Clinical Practice ◽

Cataract Surgery ◽

Exposure Time ◽

Ocular Surface ◽

Povidone Iodine ◽

Bacterial Load ◽

Minute Exposure ◽

Visual Outcomes ◽

Preoperative Prophylaxis ◽

Operating Room Staff

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.

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Liposomal drug delivery system for anti-inflammatory treatment after cataract surgery: a phase I/II clinical trial

Drug Delivery and Translational Research ◽

10.1007/s13346-021-00912-x ◽

2021 ◽

Author(s):

Chee Wai Wong ◽

Edmund Wong ◽

Josbert M. Metselaar ◽

Gert Storm ◽

Tina T. Wong

Keyword(s):

Drug Delivery ◽

Clinical Trial ◽

Phase I ◽

Cataract Surgery ◽

Drug Delivery System ◽

Delivery System ◽

Liposomal Drug ◽

Anti Inflammatory ◽

Liposomal Drug Delivery

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Comparing Vitamin A and Moist Chamber in Preventing Ocular Surface Disorders

Clinical Nursing Research ◽

10.1177/1054773817695618 ◽

2017 ◽

Vol 27 (6) ◽

pp. 714-729 ◽

Cited By ~ 2

Author(s):

Hassan Babamohamadi ◽

Monir Nobahar ◽

Jalaladin Razi ◽

Raheb Ghorbani

Keyword(s):

Clinical Trial ◽

Intensive Care Unit ◽

Intensive Care ◽

Vitamin A ◽

Ocular Surface ◽

Slight Reduction ◽

Moist Chamber ◽

Icu Patients ◽

Schirmer’S Test

The present study was conducted to determine the effectiveness of vitamin A eye ointment (VAEO) and moist chamber (MC) in preventing ocular surface disorders (OSD) in intensive care unit (ICU) patients. A total of 38 eligible patients were selected for participation in the present clinical trial. All the patients were randomly administered VAEO in one eye every 6 hr for 5 days and had a polyethylene cover (PC) placed on their other eye to create an MC that was replaced every 12 hr as well. The results of Schirmer’s test also increased by 2.06 mm in the VAEO group ( p < .001), while they showed a slight reduction by 0.15 mm in the MC group ( p = .669). VAEO was more effective in preventing OSD in ICU patients than MC and is, therefore, recommended to be used as a method of preventing OSD.

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