Comparison Of The Efficacy Of 1%, 5% Or 10% Povidone-iodine (PVI) Irrigation In Combination With Levofloxacin 0.3% As Prophylaxis In Patients Undergoing Cataract Surgery

Abstract

 

Purpose:

 

To compare the efficacy of 1%, 5% or 10% PVI irrigation in combination with levofloxacin 0.3% to decrease the number of bacteria on the conjunctiva before cataract surgery.

 

Methods:

 

After approval by the IRB of the Department of Ophthalmology, Ludwig-Maximilian University, cataract patients were asked to participate in this prospective study from July to November 2010. All patients received levofloxacin 4 times one day before surgery, then 3 groups were formed: Group I (1% PVI), Group II (5% PVI) and Group III (10% PVI). In all groups the conjunctiva was flush-irrigated with 10ml PVI respectively. Conjunctival specimen were obtained in the operating theater at 4 timepoints: T0c = no-surgery eye (control), T0 = surgery-eye, both before PVI irrigation. T1 after PVI irrigation, T2 at the end of surgery. All specimen were inoculated onto blood/chocolate agars and into thioglycolate-broth. General and clinical data were collected.

 

Results:

 

A total of 248 patients completed the study: 100 patients (Group I), 73 (Group II) and 75 in Group III (Table 1). Regarding the control smear (T0c) no significant difference in positive cultures was found. After 10 ml PVI irrigation, a strong reduction of conjunctival bacterial load noticed in all groups. The difference in positive cultures was significant comparing 1% PVI-Group and 10% PVI-Group (p = 0.04). While there was no significant difference between 1% PVI-Group and 5% PVI-Group. Blood and chocolate agars showed the same results. Coagulase-negative Staphylococcus was the most isolated bacteria and was found in the same frequency in all three groups. No corneal defect due to PVI occurred in any patients.

 

Conclusions:

 

The preoperative irrigation with 10% PVI in combination with topical levofloxacin is significantly more effective than 1% PVI in decreasing the number of bacteria before surgery.  

 

Clinical Trial:

 

https://eudract.ema.europa.eu 2010-018704-85

 

Keywords: endophthalmitis • bacterial disease • cataract