• Written By: Adam J. Gess, MD
    Cataract/Anterior Segment

    Data from this large retrospective study suggest that generous preoperative application of povidone–iodine may reduce the risk of endophthalmitis.

    The authors reviewed 68,323 intraocular surgeries conducted at a single center from 1990 to 2009. They divided the data into three sections, each corresponding to a different preoperative prophylaxis protocol:

    • No preop antiobiotic drops or standardized surgical prep (1990 to 1992);
    • Preoperative topical povidone–iodine 10.0% periorbitally, and one drop of povidone–iodine 1.0% in the conjunctiva sac (1993 to 1998); and
    • Preop antibiotics and irrigation of conjunctival fornix with 1% iodine (1999 to 2009).

    The rate of postoperative endophthalmitis decreased from 0.291% to 0.065% over the 20-year period. It decreased significantly through all periods, not only in cataract surgery cases but also in vitrectomy cases as well as in all intraocular surgery.

    The authors point out that the rates in the group with irrigation of the fornix with povidone iodine were similar to those in the ESCRS study that looked at intracameral cefuroxime. They say intracameral antibiotics should be considered if complications such as posterior capsule rupture occur. 

    They also note that the arrival of techniques such as phacoemulsification, clear corneal incisions and sutureless transconjunctival vitrectomy over this period may have influenced these results.