Second povidone-iodine application may reduce contamination in strabismus surgery

This prospective study found that a second application of povidone-iodine in patients undergoing strabismus surgery significantly decreased the rate of contamination of the surgical site and sutures.

The authors investigated whether applying a double versus a single application of povidone-iodine 5% in patients undergoing strabismus surgery would affect contamination rates.

Subjects included 104 patients aged 7 months to 79 years assigned to receive a single or double application of povidone-iodine.

All patients received four drops of povidone-iodine 5% directly into the conjunctival fornices, after which the eyelashes were cleaned with cotton tips soaked with povidone-iodine 5%. Sterile gauze pads soaked with povidone-iodine 5% were used to clean the periocular skin. After lid speculum placement, the patients in the dual application group received an additional two drops of povidone-iodine in the conjunctival fornices.

The single application group had a 25% contamination rate of surgical site and sutures, compared to 10% in the dual application group. The rate of eyelid speculum contamination was unaffected by additional applications (12.5% contamination rate in both groups). However, additional application of povidone-iodine did decrease the conjunctival incision site contamination rate from 20.5% to 5% (P = 0.02).

They write that the second application of povidone-iodine may increase contact between bacteria in crevices and along the eyelid margin with the povidone-iodine or mitigate the dilutional effect of the natural tear film and subsequent irrigation with normal saline.

They add that future studies should involve a larger number of surgeries performed at multiple surgery centers.