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.
Highlights
Cataract surgery is the most common surgery performed in ophthalmology
Since visual prognosis of endophthalmitis caused by multidrug-resistant bacteria tends to be poor due to the lack of effective antibiotics [20], prevention and treatment of endophthalmitis caused by these bacteria must be addressed
The concentrations that cause1d1 oafm20age to corneal endothelial cells, corneal epithelial cells and retina are shown; 0.025% povidone-iodine is the median for the concentration range of 0.05–0.5% that is suitable for ocular surface irrigation. (Modified from [28])
Summary
Cataract surgery is the most common surgery performed in ophthalmology. With a global cataract prevalence of approximately 50% among adults over the age of 50, cataract surgery is the most common surgical procedure performed in developed countries. Postoperative endophthalmitis after cataract surgery is typically caused by the patient’s own normal conjunctival bacterial flora [3]. Among the “three-step approach”, the “border control” that prevents the normal bacterial flora on the ocular surface from entering the eye is the most important. The transformation of non-pathogenic normal bacterial flora of the conjunctiva to pathogenic bacteria causing infection has been explained by the differences in the immunological state between the conjunctiva and the intraocular environment. For this reason, intraocular procedures including cataract surgery, vitrectomy and intravitreal injection that are performed while communicating the extraocular with the intraocular environment always carry the risk of endophthalmitis. During intraocular surgery, it is important to implement “border control” measures to prevent bacteria and fungi, viruses and other microbes from entering the eye
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