Povidone-iodine Preparation Research Articles

Efficacy and Physicochemical Evaluation of an Optimized Semisolid Formulation of Povidone Iodine Proposed by Extreme Vertices Statistical Design; a Practical Approach.

One of the most significant issues in pharmaceutical industries, prior to commercialization of a pharmaceutical preparation is the "preformulation" stage. However, far too attention has been paid to verification of the software assisted statistical designs in preformulation studies. The main aim of this study was to report a step by step preformulation approach for a semisolid preparation based on a statistical mixture design and to verify the predictions made by the software with an in-vitro efficacy bioassay test. Extreme vertices mixture design (4 factors, 4 levels) was applied for preformulation of a semisolid Povidone Iodine preparation as Water removable ointment using different PolyEthylenGlycoles. Software Assisted (Minitab) analysis was then performed using four practically assessed response values including; Available iodine, viscosity (N index and yield value) and water absorption capacity. Subsequently mixture analysis was performed and finally, an optimized formulation was proposed. The efficacy of this formulation was bio-assayed using microbial tests in-vitro and MIC values were calculated for Escherichia coli, pseudomonaaeruginosa, staphylococcus aureus and Candida albicans. Results indicated the acceptable conformity of the measured responses. Thus, it can be concluded that the proposed design had an adequate power to predict the responses in practice. Stability studies, proved no significant change during the one year study for the optimized formulation. Efficacy was eligible on all tested species and in the case of staphylococcus aureus; the prepared semisolid formulation was even more effective.

AUA Quality Improvement Summit 2014: Conference Proceedings on Infectious Complications of Transrectal Prostate Needle Biopsy

IntroductionThe AUA Quality Improvement Summit is a continuing AUA effort to provide education around issues related to quality improvement and patient safety. Due to the rapidly increasing rates of hospitalization following prostate needle biopsy, Infectious Complications of Transrectal Prostate Needle Biopsy was selected as the inaugural topic. MethodsThe information is largely unpublished data provided by the presenting physicians. Infection rates are predominantly self-reported with protocols specified by the physicians' home institutions. Beyond the identified speakers, the open forum of this summit allowed for input from a majority of the participants. ResultsCurrent hospitalization rates for transrectal prostate needle biopsy infections vary widely from 0.5% to 6%. Antibiotic resistance of coliform organisms appears to be a major risk of these infectious complications. Prophylactic protocols also vary widely among the represented institutions. Antibiotic resistance profiles showed extreme regional variation and, as such, a prophylactic antibiotic protocol should be based on the current local antibiogram in order to reduce infection rates. Opinions vary in relation to the specific antibiotics appropriate for an augmented antibiotic prophylaxis, in the use of rectal swab and prebiopsy enema, and povidone-iodine preparation of the rectal vault. Standardization of the transrectal antibiotic prophylaxis across practices has been proven to reduce the infectious complications rates. ConclusionsUrologists should monitor the prostate biopsy infection rates of the practice and consult the current local antibiogram. Physicians should query patients to assess whether they are at high risk for resistant organisms. If so, prophylactic protocols might be intensified.

Skin preparation before surgery: options and evidence.

Despite many advances in surgical asepsis, surgical site infection (SSI) remains a challenging and costly problem. Decontamination of the skin with an antiseptic agent is standard practice before any trans-cutaneous invasive procedure, but the antiseptic agent of choice to best reduce the risk of SSI remains controversial. Review of relevant literature. Many randomized controlled trials (RCTs) have evaluated chlorhexidine-based and iodine-based preparation solutions, with and without an alcohol component. Most of these trials are underpowered to detect differences in SSI rates. The largest modern RCT showed that a chlorhexidine-isopropyl alcohol preparation reduced the risk of SSI substantially compared with a povidone-iodine preparation without alcohol in clean-contaminated surgery. Many smaller RCTs have shown that chlorhexidine-isopropyl alcohol is superior to povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol in pre-operative skin decontamination; whether or not this translates into lower SSI rates is unknown. A mixed treatment comparison of 10 RCTs concluded that alcohol-based preparations have a 98% probability of reducing the risk of SSI more effectively than aqueous-based preparations. Non-randomized observational studies have generally found no difference in SSI rates among various skin antiseptic preparations. Alcohol-based agents are likely superior to aqueous agents. Chlorhexidine may decrease SSI rates compared with povidone-iodine, and chlorhexidine-isopropyl alcohol likely offers better skin decontamination before clean surgery than povidone-iodine plus isopropyl alcohol or iodine povacrylex plus isopropyl alcohol. The quality of the available data is moderate. Rigorous, well-powered RCTs with appropriate treatment comparisons are needed to establish the optimal and most cost-effective pre-operative skin preparation in various operations and wound classifications.

Bilateral same-session intravitreal injections of anti-vascular endothelial growth factors.

To document the indications, safety and possible complications of bilateral same-session intravitreal anti-vascular endothelial growth factor (VEGF) injections performed in the ophthalmic operating room. A retrospective case series study. Consecutive records of seventy four patients receiving simultaneous bilateral intravitreal injections of either ranibizumab or bevacizumab, between September 2010 and September 2013, were reviewed and the outcomes were assessed. Data collected included number of injections, indications for injections, pre-injection and post-injection visual acuity (VA), pre-injection and post-injection intraocular pressure and ocular and systemic complications/complaints after each injection. A total of 342 injections were administered to 74 patients, with a mean of 4.62 injections per patient. Seventy-three patients received bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA) alone, and only one patient received both bevacizumab and ranibizumab (Lucentis; Genentech Inc.) distributed between the injections. Pre- and post-injection VA follow-up measurements were available for 65 patients. Mean follow up period was 22mo. The indications for initiating therapy were choroidal neovascular membrane from age-related macular degeneration (3 patients) and diabetic macular edema (71 patients). The mean Snellen VA before each injection was 6/22. The next post-injection follow-up mean Snellen VA was 6/20. One patient had a painful, culture-positive endophthalmitis in one eye 3d after bilateral bevacizumab. Another patient had a painless subconjunctival hemorrhage in one eye. No other ocular or systemic adverse side effects/complaints have been registered in this study group. Bilateral same-session intravitreal injections using a separate povidone-iodine preparation, speculum, needle, and syringe for each eye are well-tolerated. None of the subjects in this study requested to switch to alternating unilateral injections. Proper patient counseling as to the risk of complications with this procedure is necessary.

Intraoperative apnea in children after buffered 5% povidone-iodine site sterilization for strabismus surgery.

Presurgical preparation for ocular surgery typically utilizes a buffered 5% povidone-iodine preparation solution. It was our observation that a significant number of spontaneously ventilating patients under sevoflurane anesthesia would become apneic upon ophthalmic instillation of this solution. This study was performed to confirm or refute this observation and to determine whether there were any patient variables that might predict this phenomenon. After Institutional Review Board (IRB) approval, thirty pediatric patients scheduled for strabismus surgery were enrolled. Anesthesia was induced and maintained with sevoflurane via laryngeal mask airway, and all patients were breathing spontaneously. All patients received preoperative sedation with oral midazolam (0.5 kg·kg(-1), maximum 12 mg). Presurgical preparation was performed with saline wash followed by instillation of buffered 5% povidone-iodine solution. Respiratory rate was recorded at the time of surgical preparation. Apnea was defined as lack of respiratory effort for 20 s or greater. Data from twenty-eight children (ages 1.4-11 years) were ultimately recorded. Fifteen of the twenty-eight patients developed apnea (median duration 40, IQR 37, range 20-262 s) at the time of surgical site preparation. Apnea at the time of ocular preparation with buffered 5% povidone-iodine solution is common. The precise mechanism of this response is unknown.

Prevention and treatment of injection-related endophthalmitis.

Intravitreal injections are the fastest growing cause of endophthalmitis and can result in severe vision loss. The prevention, diagnosis and management of such infections remain unclear and at times controversial. We searched Pubmed for keywords "prophylaxis," "endophthalmitis," "intravitreal injection." We focused on studies published in the last 2 years as well as other recent studies with particular attention to data on the incidence, microbiology, prevention, and treatment of injection-related endophthalmitis. Over 20 relevant studies were found. With povidone-iodine preparation, the per-injection endophthalmitis rate is low at about 0.03%. Antibiotics do not appear to be beneficial for prevention of post-injection endophthalmitis. The best timing of vitrectomy is unclear. Antibiotic prophylaxis is probably not needed when giving intravitreal injections. More data is needed to help determine the proper treatment for post-injection endophthalmitis.

Progression of endophthalmitis clinical characteristics and coping strategy of bacterial post-vitrectomy

Bacterial endophthalmitis is a real rare complication, perhaps the most devastating one,following pars plana vitrectomy. The most common organism responsible for it is coagulase-negative Staphylococcus. Potential predisposing factors of post-vitrectomy endophthalmitis are majorly coming from surgical procedures and compromising of the immune system. Preoperative povidone-iodine preparation received the clinical recommendation for prophylactic interventions. The main choices of bacterial endophthalmitis treatments are intravitreal injection of antibiotics according to etiological diagnoses and vitrectomy.

Conjunctival Flora Antibiotic Resistance Patterns After Serial Intravitreal Injections Without Postinjection Topical Antibiotics

To report conjunctival bacterial flora antibiotic resistance patterns after serial intravitreal injections performed using a povidone-iodine preparation without the use of preinjection or postinjection topical antibiotics. Prospective, interventional case series. Single-center clinical practice in Pennsylvania. Thirteen eyes of 13 treatment-naïve patients undergoing serial intravitreal anti-vascular endothelial growth factor (VEGF) injections for exudative age-related macular degeneration or macular edema attributable to retinal vein occlusion. Conjunctival cultures from the treatment eye were performed prior to each injection preparation. A minimum of 3 monthly conjunctival cultures were obtained per eye over the course of the study. Ocular surface preparation consisted of topical anesthetic and povidone-iodine 5% without the use of preinjection or postinjection topical antibiotics. Conjunctival flora growth patterns and antibiotic resistance patterns to several common antibiotics tested over the course of the study. A total of 48 cultures were performed with a 77% culture positivity rate. Over the course of the serial conjunctival cultures in each patient, there was no evidence for emergence of resistant bacteria to any of the tested antibiotics (including fluoroquinolones and azithromycin) or significant alteration from baseline conjunctival flora. Of the 47 bacterial isolates, the most commonly isolated organism was coagulase-negative Staphylococcus both at baseline (73%) and following serial intravitreal injections (78%, P = .73). Ocular surface preparation for intravitreal injection using povidone-iodine 5% alone in the absence of postinjection topical antibiotics does not appear to promote bacterial resistance or a discernible change in conjunctival flora.

Committee Opinion No. 571

Currently, only povidone-iodine preparations are approved for vaginal surgical-site antisepsis. However, there are compelling reasons to consider chlorhexidine gluconate solutions for off-label use in surgical preparation of the vagina, especially in women with allergies to iodine. Although chlorhexidine gluconate solutions with high concentrations of alcohol are contraindicated for surgical preparation of the vagina, solutions with low concentrations of alcohol (eg, 4%) are both safe and effective for off-label use as vaginal surgical preparations and may be used as an alternative to iodine-based preparations in cases of allergy or when preferred by the surgeon.

Discourage the presurgical spray tan: Physicians were puzzled by the patient's postoperative skin damage

Krause. Discourage the presurgical spray tan. Am J Obstet Gynecol 2013. Case notes A 34-year-old woman underwent robotic-assisted lysis of adhesions, vaporization of endometriosis, and a myomectomy. She had a vague history of an allergic reaction to an unknown stimulus during anesthesia. The patient was prepped with 2% chlorhexidine gluconate and 70% isopropyl alcohol scrub (ChloraPrep; CareFusion Corp, San Diego, CA) for the abdomen and 10% povidone iodine preparation solution (Aplicare Inc, Meriden, CT) for the perineum and draped. After the operative procedure, we noted erythema and what appeared to be disruption of the deep dermal skin layer in areas where the adhesive tape had been applied. A noticeable contrast in skin pigmentation existed in the affected areas, raising further concern for skin damage and denudement (Figure). Bacitracin ointment was applied. Postoperatively, the patient revealed that she had undergone a spray tan 2 days before her operation. Consultation with a wound-care specialist confirmed that the spray tan had been removed in the areas where the adhesive tape was in direct contact with the skin. Although apoptotic layers may have been removed, the skin was intact.

Iatrogenic skin injury in hospitalized patients

Iatrogenic skin injuries in hospitalized patients range from drug-related complications to those related to procedures. Common drug complications include drug reaction with eosinophilia and systemic symptoms (DRESS), linear immunoglobulin (Ig) A bullous dermatosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. Contact dermatitis can result from surgical preparations of chlorhexidine and povidone-iodine, medical adhesives, topical postsurgical ointments, most commonly neomycin and bacitracin, and internal prostheses, including coronary stents, pacemakers, and metal joints. Complications arising from procedures include thrombosis caused by placement of peripherally inserted central catheters, pyoderma gangrenosum from sites of dermal trauma, and anetoderma of prematurity from cutaneous monitoring devices in neonates. Calcinosis cutis and decubitus ulcers are also hospital problems.

Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs

Objective Povidone-Iodine preparation is used as a disinfectant in otological surgeries. The ototoxicity of Povidone-Iodine preparation was evaluated using infant, young and adult guinea pigs. The effects of different concentrations and of different exposure durations on compound action potentials were also studied. Materials & methods Povidone-Iodine was used to fill one middle ear cavity of the guinea pig, and the compound action potential (CAP) was measured from the round window membrane at 24 h, 7 days, and 28 days. The contralateral side was filled with saline as control. Test sounds used were clicks and tone bursts of 2, 4, and 8 kHz. Results At 24 h, Povidone-Iodine solution showed a significant toxic effect in the infant group. In the young animal group, no toxic effect was seen. In the adult group, a mild degree of deafness for 2 kHz was found. At 7 days, the young group showed significant hearing loss for all frequencies, but the adult group did not show any hearing loss. With a half strength solution, both young and adult group did not show hearing loss. At 28 days, with a full strength solution, hearing loss became prominent for all sound stimulation. With 1/8th dilution, the young group showed a moderate hearing loss, but the adult group did not. Conclusion The thicker round window membrane in human is expected to provide more protection to the human cochlea than in the guinea pig model that we have studied. Mild hearing loss at 24 h and 7 days using 10% solution, but no hearing loss with 5% solution at 7 days may indicate that rinsing of the middle ear cavity with saline during surgery should minimize the ototoxic effect of this product. The age of the animals does influence the outcome of the ototoxicity experiment. From this experiment, Povidone-Iodine preparations in the infant should be used with caution. Povidone scrub should not be used for otologic surgery.

Antimicrobacterial Effects and Cytotoxicity of Povidone-Iodine Preparation: Influence of Additional Surfactant

Antimicrobacterial Effects and Cytotoxicity of Povidone-Iodine Preparation: Influence of Additional Surfactant

A study on the incidence, microbiological analysis and investigations on the source of infection of postoperative infectious endophthalmitis in a tertiary care ophthalmic hospital: An 8-year study

Background:The objective of the study was the determination of the incidence of culture-proven postoperative endophthalmitis and probable sources of infection.Materials and Methods:It was a prospective study on the microbiology, incidence and probable sources of infection in patients with postoperative infectious endophthalmitis carried out in a tertiary care eye hospital. Consecutive patients diagnosed with postoperative infectious endophthalmitis during the years 2000-2007 were investigated for the causative infective agent and possible sources of infection. The surgical data and microbiological data including the investigations performed to trace the source were recorded in a specific formatted form and were gathered and compiled for analysis.Results:Data of analysis showed that 98 (0.042%) out of 2,31,259 patients who underwent intra-ocular surgery developed infectious endophthalmitis. Among these, 70 (0.053%) occurred after cataract, 10 (0.5%) after penetrating keratoplasty (PK) and 18 (0.018%) following other types of intra-ocular surgeries. The predominant infectious agents isolated were bacteria (89.7%), with equal proportions of Gram-positive and Gram-negative bacteria. Polymicrobial infection was noted in four and fungi in seven patients. Occurrence of postoperative endophthalmitis was sporadic and not related to any specific part of period in a year. Sources of infection were donor corneal rim in six post-PK patients and phaco probe in one who had postphacoemulsification endophthalmitisConclusions:Overall incidence of postoperative endophthalmitis over an 8-year period was quite low. The sources of infection could be established in six post-PK endophthalmitis patients and in a postcataract surgery.

A Prospective Randomized Evaluation of Topical Gatifloxacin on Conjunctival Flora in Patients Undergoing Intravitreal Injections

We sought to assess the efficacy of 3-day topical gatifloxacin use in combination with povidone-iodine (PVI) versus PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal (IVT) injection. Prospective, randomized single-blind clinical trial. We included 129 patients scheduled to undergo 273 IVT injections at California Vitreoretinal Center at Stanford University. Study patients were randomized to self-administration of gatifloxacin drops for 3 days before injection, or no pretreatment antibiotics. Cultures were collected from the bulbar conjunctiva at the injection site and at the corresponding location in the fellow eye before PVI preparation. After topical PVI treatment and immediately before injection, a third culture was obtained at the injection site. Additionally, the injection needle was also cultured after the procedure. Incidence of positive bacterial samples collected from injection site conjunctiva and injection needles. Three-day gatifloxacin use resulted in a significantly lower rate of SeptiChek (Becton Dickinson, Franklin Lakes, NJ) positive cultures compared with untreated controls (21% vs 48% respectively, P = 0.005). After topical PVI, the rate of positive bacterial cultures in gatifloxacin-treated and control eyes were similar (8% and 4%, respectively; P = 0.324). Although 3-day topical gatifloxacin use is effective in reducing the frequency of conjunctival bacterial growth relative to untreated eyes, antibiotic use confers no additional benefit in combination with PVI than eyes receiving PVI alone. This supports that topical PVI is an effective preinjection monotherapy for infection prophylaxis in the setting of IVT injections.

Bilateral Simultaneous Intravitreal Injections in the Office Setting

To report the outcomes and complications of bilateral simultaneous intravitreal injections performed in the office. Retrospective case series. Records of 35 patients receiving simultaneous bilateral intravitreal injections between November 2007 and November 2008 were reviewed. Data collected included indication for injection, preinjection and postinjection intraocular pressure (IOP), preinjection and postinjection visual acuity (VA), and complications/complaints after each injection. A total of 208 injections were administered to 35 patients, with a mean of 5.9 injections per patient (range, 2 to 14; standard deviation [SD], 3.68). One hundred and thirty-three eyes received bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) alone, 14 received bevacizumab plus preservative-free intravitreal triamcinolone or Triescence (Kenalog; Bristol-Myers Squibb Co, New York, New York, USA), 56 received ranibizumab (Lucentis; Genentech Inc), and 5 received bevacizumab plus dexamethasone (Decadron; Merck, Whitehouse Station, New Jersey, USA). Mean time of postinjection follow-up was 39 days. Postinjection VA follow-up measurements were available for 194 injections. The indication for initiating therapy was choroidal neovascularization from age-related macular degeneration (49 eyes), diabetic macular edema (ME) (13 eyes), proliferative diabetic retinopathy (4 eyes), ME attributable to retinal vein occlusion (2 eyes), and ME attributable to autoimmune retinopathy (2 eyes). The mean VA before each injection was 20/96 and at the next follow-up was 20/91 (P = .40). One patient had a painless, culture-negative endophthalmitis in 1 eye 3 days after bilateral bevacizumab; at 1 year VA improved from 20/400 to 20/80. Simultaneous bilateral intravitreal injections in the office are well tolerated. A separate povidone-iodine preparation, speculum, needle, and syringe were used for each eye. None of the patients requested alternating unilateral injections, after receiving bilateral injections. Patients should be counseled as to the risk of complications.

Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice

Background Currently, there are various antiseptics used for cleaning the skin before surgery, but there is no standard procedure in practice. Chlorhexidine and povidone-iodine are the most preferred compounds among antiseptics. Both are proved to be safe and effective for skin disinfection. In this study, our aim was to investigate the combined effects of chlorhexidine and povidone-iodine on the skin's flora before neurosurgical intervention, consecutively. Methods Randomly, 50 cranial and 50 spine neurosurgery cases were assigned to the study. The first culture was obtained after hair removal and before cleaning the skin with any antiseptic. The second culture was obtained after the skin had been cleaned with chlorhexidine for 3 minutes. Then, the skin was cleaned twice with povidone-iodine for 30 seconds, and the third and fourth cultures were taken from the skin incision area. Bacteria were identified by means of standard laboratory identification methods. Positive culture results were compared statistically among order of cultures obtained. Results In the first culture evaluation, 39 (33 cnS, 6 Stapylococcus aureus) of 50 cranial samples and 37 (33 cnS, 4 S aureus) of 50 spine samples showed reproduction. In the second culture, 9 cranial and 5 spine samples showed reproduction of cnS. In the third and fourth cultures, no growth was observed ( P < .001). Conclusion Three minutes' cleaning of the incision area with chlorhexidine, followed by 30-second cleaning with povidone-iodine, could be a sufficient disinfection procedure for preoperative preparation of the skin in patients undergoing a neurosurgical procedure.

Toxic effects of povidone–iodine on synovial cell and articular cartilage

The objective of this study was to investigate the toxic effects of povidone-iodine (PVI). A series of MTT assay of cultured synovial cells stimulated by PVI have been made. Test for assay of membrane-toxic effect of PVI and lactate dehydrogenase (LDH) has also been carried out. After making intraarticular injection into rats' hind knee joints with 0.1 ml of PVI every day for 1 week, we have extracted the knee joints and blood from rats in four divided groups on the 0, 1st, 3rd, and 7th day. Our microscopic analysis was performed that cartilage and synovium membrane were stained with hematoxylin, toluidine blue, and safranin O. Iodine, glutamic oxaloacetic transminase, creatine phosphokinase (CPK), and LDH in rat sera have been measured. We were able to confirm cytotoxicity in the synovial cells placed in PVI concentration of more than 6.25 x 10(-2)%. In comparison with the positive control, LDH, in this case, was released at the concentration level of 33.3%. Independent of period of stimulation, LDH was released the most in the PVI concentration of 6.25 x 10(-2). The histopathological analysis of articular cartilage has indicated clear morphological alterations in rats' synovium; especially, toluidine blue staining and safranin O staining were seen in the metachromasia of articular cartilage. However, no fissures or erosive changes in the articular cartilage, which were usually observable in the case of osteoarthritis, were observed. In the synovium inflammatory cells, which were mainly plasma cells and lymphoid cells, no neutrophils were infiltrated. The degree of infiltration has increased steadily day by day. Fibrin deposition has been observed even in the synovium of 1-day stimulation. On the 7th day, a serum total iodine concentration has been 544 microg/dl, 4,440 IU/ml for CPK concentration, and 2,049 IU/ml for LDH concentration, while the control concentrations have been 7.1 microg/dl, 491 IU/ml, and 700 IU/ml, respectively. Our experiment has disclosed that PVI preparation is strongly cytotoxic to synovial cell and articular cartilage.

Acute-onset Endophthalmitis After Cataract Surgery (2000–2004): Incidence, Clinical Settings, and Visual Acuity Outcomes After Treatment

To report the incidence, clinical settings, and visual acuity outcomes of acute-onset endophthalmitis after cataract surgery. Retrospective, observational case series. Annual cataract surgery statistics were determined by review of electronic surgical records. The clinical and microbiologic records were reviewed of all patients with clinically diagnosed endophthalmitis within 6 weeks after cataract surgery at a single university-affiliated hospital between January 2000 and November 2004. main outcome measures: Operative technique, intraoperative complications, and visual acuity. The incidence of acute-onset endophthalmitis after cataract surgery was 0.04% (7/15,920) for cataract surgeries of all methods, 0.05% (6/11,462) for cataract surgery by clear cornea phacoemulsification, and 0.02% (1/4,458) for cataract surgery by methods other than clear cornea phacoemulsification (P = .681, Fisher's exact test). Six of seven (86%) cases occurred in the right eye, and all cases were performed by right-handed surgeons through temporal incisions. Five of seven (71%) patients had relative immune compromise. Four of seven (57%) patients had an intraoperative complication: vitreous loss in three patients and iris prolapse in one patient. Two patients had topical placement of lidocaine 2% gel before povidone-iodine preparation. The visual acuity at final follow up was 20/25 or better in four patients and count fingers or worse in three patients. The incidence of acute-onset endophthalmitis after temporal clear cornea incision phacoemulsification is low (0.05%). Potential risk factors for endophthalmitis may include intraoperative complications, relative immune compromise, application of lidocaine 2% gel before povidone-iodine preparation, and inferior incision location.

Postoperative endophthalmitis

Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of ∼0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and the intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did study these issues, although they are associated with specific features that may require alterations in patient management.—Hans E. Grossniklaus