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Bing Li, Yazmin Yactayo, Mariëtte Swart van den Berg, Martha J Tjon Fo Sang, Laurentius J van Rijn, Liesbeth Prick, Anselm Kampik, Herminia Mino de Kaspar, Huibert Jan Simonsz; The effectiveness of Preoperative Irrigation with 5% vs. 1.25%Povidone-iodine in reducing Conjunctival Bacterial Flora in Children undergoing Strabismus Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2593.
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© ARVO (1962-2015); The Authors (2016-present)
To reduce the occurrence of endophthalmitis after strabismus surgery in young children, the conjunctiva can be irrigated with with Povidone-Iodine (PI). We examined the optimal concentration in a multicenter RCT.
In university clinics in Amsterdam, Leiden and Rotterdam, the conjunctiva was irrigated with 1.25% or 5% PI prior to strabismus surgery in 1-to-5- year-olds. Smears were obtained with a small standard moistened swab for aerobic and anaerobic bacteria from: (T1) conjunctiva after induction of anesthesia, (T2) conjunctiva 5 minutes after PI irrigation, (T3) muscle and cut-off sutures after reattachment and (T4) at the end of surgery, from conjunctiva. A nose smear (T0) was added during the study. All specimens were inoculated in Munich onto blood/chocolate agars for three/five days and into thioglycolate-broth for five days.
70 children were recruited, 51of these had nose cultures(T0). All T0 were cultured positive with total isolated 81 bacteria. While smears from T1, 65.7% (46/70) were positive with total 51 isolated bacteria, with coagulase negative Staphylococcus (CNS) (51.0%, 26/51) as the most frequent bacteria. After 1.25% or 5% PI irrigation before surgery, only 22.9% (16/70 ) smears of T2 were positive with significant difference comparing to T1 (p=0.002). The positive smears from muscle and cut-off sutures (T3) were 28.6% (20/70), including 13 CNS, 4 Staphylococcus aureus ,3 α- hemolytic Sreptococcus and 1 Haemophillus. 13 of them have the same bacteria in T1 and T3. However, new bacteriae found in T3 that were not found in T1 for 7 patients, 2 from 5 of them (2 patients without T0) have the same bacteria with T0. 18.7% (3/16) vs. 31.5% (17/54) positive T3 cultures were found in patient with vs. without lacrimal sack massage. No signifidant differences were found 1.25% vs. 5% PI irrigation (p=0.094).
Both 1.25% and 5% PI can effectively reduce the bacteria loading on the conjunctiva before Strabismus Surgery. Coagulase negative Staphylococcus was found to be the most frequent bacterium from conjunctiva, muscle and cut-off sutures. Lactimal sack massage could prevent the bacteria reflux from the lacrimal puncta during surgery.
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