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D. E. Dahl, T. Dahl, Jr., G. Lane, D. Ferguson; Does Lidocaine Gel Decrease the Effectiveness of a Povidone-Iodine Prep?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5629. doi: https://doi.org/.
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To determine if lidocaine 2% ophthalmic gel reduces the effectiveness of povidone-iodine on eliminating conjunctival flora for standard preoperative prep for intraocular surgery.
Thirty four eyes of seventeen patients were used for the study. One eye from each participant served as control and was prepped in standard fashion for intraocular surgery. Tetracaine ophthalmic drops were administered prior to prepping. The study eye was given topical lidocaine 2% gel before prepping with povidone-iodine in the same manner as the control eye. Three minutes after the prep was complete, aerobic and anaerobic cultures were taken from the inferior conjunctival fornix of each eye. After incubation at 35 degrees Celsius for 48 hours, the number of colony forming units (CFUs) were counted. The difference in means of CFUs in each pair of study and control eyes were compared using a student t-test. As a second part to the study, lidocaine gel was plated with Staphylococcus aureus and Escherichia coli.
In comparing the percent of cultures with colony forming units, fifty percent of the control eyes had CFU’s, while thirty-one percent of study eyes did (p=0.23). When comparing the total number of colony forming units, the control eyes had a total number of 20 CFU’s compared to six in the study group (p=0.08). The total number of aerobic CFU’s was six for the control versus two for the study group (p=0.30). Lidocaine gel induced a ring of inhibition to both Staphylococcus aureus and Escherichia coli.
Our study did not show a statistical significant difference in the number of colony forming units between povidone-iodine prepped eyes with or without lidocaine jelly. There was, however, a surprising trend toward less CFU’s in the eyes that were pretreated with the lidocaine jelly (p=0.08). This is reassuring to ophthalmologists that use lidocaine jelly for anesthesia before intraocular procedures. A review of the literature revealed that high concentration topical anesthetic agents, including 2% lidocaine, have been shown to have antimicrobial activity. Lidocaine gel plated with Staphylococcus aureus and Escherichia coli showed a ring of inhibition to both bacteria. Further studies are warranted to determine if lidocaine jelly might actually be of benefit in obtaining sterility prior to ophthalmic procedures.
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