Low Efficacy of Hypochlorous Acid Solution Compared to Povidone-iodine in Cataract Surgery Antisepsis

Abstract

Background: Hypochlorous Acid Solution (HAS) is a non-irritating, odorless and transparent, pH-neutral substance having antimicrobial activity. Objective: The study aimed to compare the efficacy of HAS with a 10% povidone-iodine (PVI) solution for antisepsis in Phacoemulsification Cataract Surgery (PCS). Methods: Consecutive patients undergoing PCS in the Elbląg City Hospital, Poland, were enrolled in this prospective trial. In the morning just before surgery a swab was taken from the inferior conjunctival fornix of the eye that was to be operated. Patients were assigned to receive conjunctival irrigation with PVI or HAS in the operating room. Three minutes after lavage with PVI or HAS, conjunctival swabs were taken. During surgery the cornea and conjunctival sac were irrigated with Ringer’s lactate. The last swab was taken before removing the eye speculum. Results: Overall, 110 patients completed the study; there were 59 patients in the PVI group and 51 patients in the HAS group. Conjunctival lavage with 10% PVI resulted in a decrease in bacterial load, while HAS application did not. In the HAS group a reduction in bacterial load was found after surgery. Patients after HAS irrigation reported significantly less discomfort associated with conjunctival lavage than with PVI. None of the patients developed postoperative endophthalmitis or any type of eye inflammation within the follow-up period. Conclusions: This study confirms the excellent antibacterial activity of a 10% povidone-iodine solution used for three minutes before cataract surgery. Conjunctival irrigation with Ringer lactate during PCS decreased the bacterial load of the conjunctival sac.