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SJ Froehlich, M Samudio, F Laspina, j Carrón, V Klauss, R Chang, H Mino de Kaspar; Role of Topical Ciprofloxacin and 5%-Povidone-Iodine prior to cataract surgery: a randomized study in Paraguay . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1572.
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Purpose:Intraoperative spread of conjunctival germs can cause acute or chronic endophthalmitis after surgery. Therefore, prevention based on intense antibiotic and antiseptic treatment is of great importance. This study evaluates the effectiveness of preoperative topical ciprofloxacin combined with 5% povidone-iodine in reducing conjunctival bacteria counts as well as compares each individually. Methods:Conjunctival smears were obtained from a total of 148 patients who underwent cataract surgery. The smears were taken before and after disinfection with 5% povidone-iodine as well as at the end of the surgery. The intervention group (n=87) received local ciprofloxacin every 6 hours starting 1 day prior to surgery, while the control group (n=61) did not. The specimens were analyzed according to standard microbiology methods. Results:From the smears collected before antisepsis, positive cultures were found in 80% (49 out of 61) of the control group without ciprofloxacin and 56% (49 out of 87) of the intervention group having received topical ciprofloxacin. The difference was statistically significant (p<0,005). An additional significant reduction of culture-positive smears was achieved by the use of antiseptics in both groups (p<0,005): when comparing smears after disinfection with 5% povidone-iodine, we found positive cultures in 18% (11 out of 61) of the control group and 13% (11 out of 87) of the intervention group (difference between both groups not statistically significant). Conclusion:Local antibiotic administration alone, started 1 day prior to cataract surgery and before antisepsis, results in a reduction of culture-positive conjunctival smears from 80% to only 56%. The addition of 5% povidone-iodine enables significant reduction of culture-positive conjunctival smears down to 18% in patients without antibiotic prophylaxis and to 13% in antibiotic pretreated patients. Thus, antibiotic use does not result in any significant additional benefit over antisepsis. Reduction of conjunctival germs is mainly the effect of antiseptic agents, which are the mainstay for preventing postsurgical infections.
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