Article

The effect of povidone iodine flush versus drops on conjunctival colonization before intravitreal injections.

Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 523, Little Rock, AR 72205, USA.
International Ophthalmology 11/2007; 27(5):307-12. DOI:10.1007/s10792-007-9073-6
Source: PubMed

ABSTRACT To determine the most effective method of applying povidone iodine 5% to decrease conjunctival colonization before intravitreal injections.
Twenty-eight patients from two tertiary care centers undergoing intravitreal injection for diffuse diabetic macular edema, exudative age-related macular degeneration, venous occlusive disease, or refractory pseudophakic cystoid macular edema were prospectively randomized to two study arms. One arm received 2-3 drops of 5% povidone iodine (drops group) and the second received a 10 ml flush of the same solution (flush group). The inferior conjunctival fornix was cultured before and after antiseptic technique was performed in all patients. Three culture media, thioglycollate broth, chocolate agar and blood agar, were used for each sample.
Each study group had 14 patients. Prior to antisepsis, 22 of the 28 (78.6%) subjects had positive conjunctival cultures. 16 and 14 bacterial organisms were isolated in the first and second groups, respectively. After using 2-3 drops of 5% povidone iodine in the first study arm of patients, three of 16 (18.7% reduction) bacterial organisms were no longer isolated in thioglycollate broth media. With flush irrigation of 10 ml of 5% povidone iodine, seven of 14 (50% reduction) bacterial organisms were no longer isolated (P-value 0.07) in broth media. No difference in reduction of bacterial colonization was found on plated media (chocolate agar and blood agar).
Irrigating the conjunctival fornix with 5% povidone iodine results in greater reduction of bacterial colonization compared with drop application of the same solution. Flush irrigation may provide better protection against the risk of endophthalmitis with intravitreal injections.

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Keywords

10 ml flush
 
14 bacterial organisms
 
5% povidone iodine
 
5% povidone iodine results
 
50% reduction
 
applying povidone iodine 5%
 
bacterial colonization
 
broth media
 
culture media
 
decrease conjunctival colonization
 
diffuse diabetic macular edema
 
exudative age-related macular degeneration
 
Flush irrigation
 
greater reduction
 
inferior conjunctival fornix
 
intravitreal injections
 
plated media
 
study arms
 
thioglycollate broth media
 
venous occlusive disease
 

Ammar Safar