Incidence of endophthalmitis after phacoemulsification cataract surgery: a Meta-analysis.

AIM: To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery (PCS). METHODS: The PubMed and Web of Science databases were searched from inception to April 30th, 2021. We included studies that reported on the incidence of endophthalmitis following PCS. The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale. The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity. The publication bias was assessed by Egger's linear regression and Begg's rank correlation tests. RESULTS: A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis. For overall incidence of endophthalmitis after PCS, the Meta-analysis yielded a pooled estimate of 0.092% (95%CI: 0.083%-0.101%). The incidence appeared to decrease with time (before 2000: 0.097%, 95%CI: 0.060%-0.135%; 2000 to 2010: 0.089%, 95%CI: 0.076%-0.101%; after 2010: 0.063%, 95%CI: 0.050%-0.077%). Compared with typical povidone-iodine solution (0.178%, 95%CI: 0.071%-0.285%) and antibiotics subconjunctival injections (0.047%, 95%CI: 0.001%-0.095%), the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS (0.045%, 95%CI: 0.034%-0.055%, RR: 7.942, 95%CI: 4.510-13.985). CONCLUSION: Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics, the incidence of endophthalmitis following PCS shows a decreasing trend over time. The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Review: Perspective on ocular toxicity of presurgical skin preparations utilizing Chlorhexidine Gluconate/Hibiclens/Chloraprep.

BACKGROUND: Chlorhexidine Gluconate (CHG), Hibiclens (4% CHG with 4% Isopropyl Alcohol Detergent), and Chloraprep (i.e. labeled CHG-based solutions), utilized as preoperative surgical preparatory solutions may all cause severe oculotoxicity and ototoxicity. Alternatively, 10% Povidone-Iodine (PI) solutions without detergent demonstrate minimal toxic effects on the eyes and ears. METHODS: Based on studies from 1984 to 2021, we compared the safety/efficacy of CHG-based versus PI-based solutions utilized for presurgical skin preparation near the cornea/eyes and ears (i.e., predominantly for cranial or cervical spine surgery). RESULTS: Some studies documented that even minimal exposure (i.e., "splash risk") during face/neck skin preparation with CHG-based solutions could result in irreversible corneal injury and ototoxicity. Within minutes to hours, CHG-based non-detergent solutions posed the risks of; corneal epithelial edema, anterior stromal edema, conjunctival chemosis, bullous keratopathy, and de-epithelialization. Notably, even occlusive dressings like Tegaderm could not protect against CHG penetration. Alternatively, PI-based solutions posed no to minimal ocular and/or ototoxicity, while often demonstrating comparable protection against surgical site infections (SSI). CONCLUSION: Chlorhexidine Gluconate (CHG), Hibiclens, and Chloraprep (i.e. CHG-based solutions) are often used as skin preparations near the face/eyes/spine (i.e., particularly anterior/posterior cervical procedures). However, if these solutions come in contact with the eyes, corneal irritation, abrasions, and even blindness may result. Alternatively, PI non-detergent solutions demonstrate safety/minimal oculotoxicity/ototoxicity, while frequently showing comparable efficacy against SSI.

Bleeding reduction after topical application of tranexamic acid together with Betadine solution in total knee arthroplasty. A randomised controlled study.

INTRODUCTION: Topical application of tranexamic acid to the knee joint before closure in total knee arthroplasty reduces postoperative bleeding without increase in complication. However, it is unknown the effectiveness of topic TXA performed with other topical medications, like povidone-iodine solution. MATERIALS AND METHODS: One hundred and twenty-five patients were randomized to receive 100mL of povidone-iodine solution (control: group A) or 1.5 (group B) and 3.0 g (group C) of topical TXA in povidone-iodine solution applied into the knee before closure in total knee arthroplasty. RESULTS: The patients in the TXA groups had higher mean postoperative hemoglobin levels (P=0.01 and P=0.03 in groups B and C, respectively) and a reduced postoperative blood loss in the TXA groups (P=0.07 and P=0.09 in groups B and C, respectively). No significant complications were observed. DISCUSSION: In this study, topical application of tranexamic acid after total knee arthroplasty together with povidone-iodine solution results in higher postoperative hemoglobin levels and lower blood loss compared with those in the control group without other complications. LEVEL OF EVIDENCE: I - I: high-powered prospective randomized trial.

Effect of Povidone-iodine Washing of Gastrointestinal Mucosa or Taking Proton Pump Inhibitors on Bacteremia after Endoscopic Ultrasonography-guided Fine Needle Aspiration.

OBJECTIVE: Few studies have evaluated the risk of bacteremia and infectious complications after endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). Therefore, we aimed to study the frequency of bacteremia and search for a method to potentially reduce bacterial infection after EUS-FNA. We also investigated the effect of taking proton pump inhibitors (PPIs) before examination on the occurrence of bacteremia. METHODS: A total of 28 healthy adult dogs were randomly assigned into three groups: control group, povidone-iodine group and omeprazole group. The dogs in the povidone-iodine group were administered with 0.5% povidone-iodine solution (10 mL) to wash gastrointestinal mucosa, while the dogs in the omeprazole group were fed with 20 mg omeprazole orally twice a day for 3 days before the EUS-FNA procedure. Blood samples were collected for cultures before EUS examination, between EUS and FNA, and 5 min, 15 min and 30 min after FNA. RESULTS: There were 3 true-positive cases of bacteremia in the control group while there was 1 true-positive case of bacteremia in each of the two experiment groups. The differences in the occurrences of bacteremia between the control group and both experiment groups were not statistically significant. CONCLUSION: There are no statistically significant differences in the frequencies of bacteremia between the two experiment groups and the control group. Therefore, washing of the gastrointestinal mucosa with 0.5% povidone-iodine solution may not reduce the risk of bacterial infection and taking the PPIs does not increase the risk of bacteremia after EUS-FNA.

Effects of gastric mucosa washing with povidone-iodine solution on bacteremia after endoscopic ultrasonography-guide fine needle aspiration / 中华消化内镜杂志

Objective To study the occurrence of bacteremia and whether washing gastric mucosa with povidone-iodine could reduce its occurrence after endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA). Methods A total of 20 healthy adult dogs were randomly assigned into experimental group and control group, with 10 in each. The animals in experimental group underwent gastric mucosa washing with 10 ml 0. 5% povidone-iodine solution before FNA, while those in control group with 10ml normal saline. Blood samples were collected for culture before EUS, between EUS and FNA, and 5, 15 and 30 minutes after FNA. Results There were 3 cases of positive bacteremia in experimental group and l in control group,which were not significantly different ( P = 0. 582). Conclusion Pre-washing gastric mucosa with 0. 5% povidone-iodine solution cannot reduce bacterial infection after EUS-guided FNA.

Validation on Method of Microbial Limit Test of Povidone Iodine Solution / 中国药房

OBJECTIVE:To establish a microbial limit test method for povidone iodine solution.METHODS:Validation on methodology of the microbial limit test of povidone iodine solution was performed using plating method(Ⅰ),culture agent dilution method(Ⅱ),membrane-filter procedure method(Ⅲ)and sodium thiosulfate neutralization in combination with membrane-filter procedure method(Ⅳ).RESULTS:The recovery rates of all of the test organisms in method Ⅰ and method Ⅱ approached zero,less than 70% in method Ⅲ but above 85% in method Ⅳ.The growth of the control bacteria was abnormal in method Ⅱand method Ⅲ,but normal in method Ⅳ.CONCLUSION:It is advisable to adopt the method Ⅳ for microbial limit test of povidone iodine solution.