Reduction of endophthalmitis rate after cataract surgery with preoperative 5% povidone-iodine.
OBJECTIVE
Postoperative endophthalmitis reflects in part quality and safety aspects of cataract surgery. Preoperative 5% povidone-iodine was introduced as a quality improvement effort. This study evaluated the effect of this additional measure on the occurrence of endophthalmitis after cataract surgery.


METHODS
Topical 5% povidone-iodine solution was applied onto the ocular surface just prior to transferring the patient into the operative theater for cataract surgery. Other prophylactic measures were allowed to continue as before. Patients developing postoperative intraocular inflammation and undergoing intravitreal antibiotic injection were included as occurrences of endophthalmitis. Alteration in endophthalmitis rate was analyzed using a 'p control chart' of a statistical process control method. The incidence in the povidone-iodine-receiving group was compared to those before implementation and concurrent nonreceiving groups.


RESULTS
The postoperative endophthalmitis rate showed a significant reduction after introduction of povidone-iodine. A year before, 9 of 3,052 eyes developed endophthalmitis (0.294%). After introduction, this occurred in 4 of 4,089 eyes receiving povidone-iodine (0.097%) and 1 of 502 nonreceiving eyes (0.199%) in the following 16 months. Despite the apparent lower rate, comparison between groups was not statistically significant. Moderate to severe but tolerable eye irritation after application was reported in 6.6%. No other adverse events were detected.


CONCLUSIONS
Topical preoperative 5% povidone-iodine contributed an additional effect to the reduction of the postoperative endophthalmitis rate after cataract surgery. This measure was rather safe to apply as a prophylaxis against endophthalmitis in cataract surgery.
Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siatr@mahidol.ac.th
Adisak
A
Trinavarat
La-ongsri
LO
Atchaneeyasakul
Cherdchai
C
Nopmaneejumruslers
Kantima
K
Inson
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002387:Cataract Extraction / Q000009:adverse effects*; D002675:Child, Preschool; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000008:administration & dosage*; D011300:Preoperative Care; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine