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Intraoperative Iodine Disinfection for Cataract Surgery [Letter]
Authors Matsuura K , Inoue Y
Received 11 January 2023
Accepted for publication 18 January 2023
Published 23 January 2023 Volume 2023:16 Pages 389—390
DOI https://doi.org/10.2147/IDR.S404373
Checked for plagiarism Yes
Editor who approved publication: Professor Suresh Antony
Kazuki Matsuura,1,2 Yoshitsugu Inoue2,3
1Nojima Hospital, Kurayoshi-city, Tottori, 6820863, Japan; 2Tottori University, Yonago-city, Tottori, 6838504, Japan; 3Hino Hospital, Hino-gun, Tottori, 6894504, Japan
Correspondence: Kazuki Matsuura, Nojima Hospital, 2714-1, Sesaki-machi, Kurayoshi-city, Tottori, 6820863, Japan, Tel +81-858-22-6231, Fax +81-858-22-6843, Email [email protected]
View the original paper by Dr Jiang and colleagues
Dear editor
We read the interesting paper by Jiang et al, who conducted a multicenter survey on the incidence, prophylaxis, and prognosis of endophthalmitis after cataract surgery in Northern China.1 The authors described the significantly decreased acute endophthalmitis incidence after the application of 0.5% povidone-iodine (PVP-I) for conjunctival washing.
In 2016, we surveyed perioperative endophthalmitis prophylaxis for cataract surgery in Japan (Table 1).2 Preoperative skin and conjunctival washing with PVP-I is popular, and >90% of surgeons employ these measures in Japan.
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Table 1 Intraoperative Endophthalmitis Prophylaxis in Japan/China |
Appropriate use of antibiotics is becoming increasingly important to reduce antimicrobial resistant bacteria worldwide.3 Intracameral antibiotic, which uses high-concentration antibiotics, is effective against antimicrobial resistant bacteria and less likely to produce antimicrobial resistant bacteria because of their single administration.
In recent years, the concept of intraoperative iodine disinfection has spread outside the field of ophthalmology, such as orthopedics, nerve and chest surgery, and gynecology, to avoid surgical site infection.4,5 Intraoperative iodine disinfection for cataract surgery6,7 is common in Japan, and 48% of surgeons adopt this procedure.2 Iodine disinfection is effective against antimicrobial resistant bacteria regardless of the drugs and does not produce antimicrobial resistant bacteria.
In the present letter, previous data were recalculated and the effects of postoperative endophthalmitis prevention measures, including intraoperative iodine disinfection, were examined (Table 2). This study included 546 surgeons and 183,432 cases, and endophthalmitis was developed in 21 cases within 1 month postoperatively. Two-sided Fisher’s exact test was used for statistical analysis, and probability values of <0.05 were considered significant.
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Table 2 Occurrence of Endophthalmitis with and/or without the Prophylactic Measures |
The antibiotics were administrated intracamerally in 8% (15,839) of cases. None of the cases had endophthalmitis, but with no statistical significance.
Of the 284 and 262 surgeons without and with intraoperative iodine, 14 (4.92%) and 4 (1.53%) experienced endophthalmitis, respectively, which was a significant decrease (p=0.031). Endophthalmitis occurred in 16 of 90,342 cases (0.018%) without intraoperative iodine and in 5 of 93,090 cases (0.005%) with intraoperative iodine, which was significantly lower (p=0.016).
Intraoperative iodine disinfection is effective to prevent endophthalmitis after cataract surgery.
Disclosure
Dr Yoshitsugu Inoue reports grants from Santen Pharmaceutical Company, outside the submitted work. The author reports no other conflicts of interest in this communication.
References
1. Jiang X, Wan Y, Yuan H., et al. Incidence, prophylaxis and prognosis of acute postoperative endophthalmitis after cataract surgery: a multicenter retrospective analysis in Northern China from 2013 to 2019. Infect Drug Resist. 2022;15:4047–4058. doi:10.2147/IDR.S332997
2. Matsuura K, Mori T, Miyamoto T, et al. Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery. Clin Ophthalmol. 2014;8:2013–2018. doi:10.2147/OPTH.S64756
3. Mendelson M, Matsoso MP. The world health organization global action plan for antimicrobial resistance. S Afr Med J. 2015;105(5):325. doi:10.7196/SAMJ.9644
4. Goswami K, Austin MS. Intraoperative povidone-iodine irrigation for infection prevention. Arthroplast Today. 2019;5(3):306–308. doi:10.1016/j.artd.2019.04.004
5. Onishi Y, Masuda K, Tozawa K, Karita T. Outcomes of an intraoperative povidone-iodine irrigation protocol in spinal surgery for surgical site infection prevention. Clin Spine Surg. 2019;32(10):E449–E452. doi:10.1097/BSD.0000000000000908
6. Shimada H, Arai S, Nakashizuka H, Hattori T, Yuzawa M. Reduction of anterior chamber contamination rate after cataract surgery by intraoperative surface irrigation with 0.25% povidone-iodine. Am J Ophthalmol. 2011;151(1):11–17.e1. doi:10.1016/j.ajo.2010.07.002
7. Matsuura K, Miyazaki D, Sasaki SI, Yakura K, Inoue Y, Sakamoto M. Effectiveness of timely intraoperative iodine irrigation during cataract surgery. Jpn J Ophthalmol. 2016;60(6):433–438. doi:10.1007/s10384-016-0471-z
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