title: Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery.
abstract: OBJECTIVE
  To elucidate Japanese trends for perioperative disinfection and antibiotic selection during cataract surgeries.
  
  
  METHODS
  Perioperative iodine use and antibiotic prophylaxis for cataract surgery were surveyed in eight regions in Japan by mail or through interviews from February 1 to March 1, 2014.
  
  
  RESULTS
  We surveyed 572 surgeons, of whom 386 (67%) responded. Most of the surgeons (94%) used iodine compounds before surgery for periocular skin disinfection (povidone-iodine [PI]: 79%; polyvinyl alcohol-iodine [PAI]: 15%) or conjunctival disinfection (85%; PI: 36%; PAI: 49%). Preoperative conjunctival iodine was primarily used as an eye wash (irrigation: 95%) and less often as an eye drop (5%). It was determined that 31% of surgeons waited 30 seconds or more between periocular disinfection and conjunctival disinfection. During surgery, 14% of surgeons used iodine several times, including immediately before intraocular lens insertion, and 7% used the Shimada technique (repeated iodine irrigation). Preoperative antibiotic eye drops were used by 99% of surgeons, and antibiotics were added to the irrigation bottle by 22%. The surgeons reported use of subconjunctival antibiotic injections (23%), antibiotic ointments (79%), and intracameral antibiotics (7%: 22 moxifloxacin; 6 levofloxacin). All surgeons prescribed postoperative eye drops, with 10% initiating the drops on the day of surgery.
  
  
  CONCLUSIONS
  Iodine compounds are commonly used preoperatively, but few institutions use iodine compounds intraoperatively, particularly with repeated application. The selection of antibiotic administration and disinfection technique has to be at the surgeon's discretion. However, intracameral antibiotic and intraoperative iodine compound use are techniques that should be widely recognized.
authors.affiliation: Nojima Hospital, Kurayoshi, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Matsuura
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: Department of Ophthalmology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Suto
authors.affiliation: Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Saeki
authors.affiliation: Tonosho Central Hospital, Kagawa, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Shiga University of Medical Science, Otsu, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kawamura
authors.affiliation: Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohkubo
authors.affiliation: Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan ; Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanito
authors.affiliation: Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Inoue
keywords: antibiotic prophylaxis; cataract surgery; endophthalmitis; intracameral antibiotic; intraoperative iodine