Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management Ophthalmology and Therapy
Abstract In this review we discuss the role of intraocular surgery preoperative prophylaxis. The correct choice of antimicrobial drug is variable in each surgical setting, according to the available strengths of evidence, the anatomical district involved, and the type of procedure. In the ophthalmic surgical field, there has been a progressive shift from antibiotic formulations, which are known to cause antibiotic resistance, to a new class of antiseptic compounds, which proved to be effective not only against bacteria, but also against fungi, protozoa, and viruses. Among these, povidone–iodine (PVI) is a water-soluble polymer that can form a complex with iodine, and the perioperative application of PVI 5–10% eye drop for 3 min is the gold standard for infection prophylaxis. A new formulation of 0.6% PVI eye drop is a new option for infection prophylaxis in the days before surgery. Chlorhexidine is a biguanide compound, which is a valid alternative with a good safety and efficacy profile and is the antiseptic of choice in patients with iodine allergy. New compounds that are currently being studied include polyhexamethylene biguanide (PHMB), picloxydine, ozone, hypochlorous acid (HOCl), and Biosecur. PHMB is a biguanide polymer that was found to be more effective than PVI in in vitro studies for reducing microorganisms and extending the duration of antisepsis, but to date, there are no formulations available on the market for preoperative ocular surgery in which it is present as main ingredient. Ozone is a molecule with oxidizing effect, which showed interesting preliminary results but is not effective against virus, Staphylococcus aureus and Candida albicans. HOCl has a natural bactericidal propriety but its applicability to prophylaxis of ocular infection in the setting of ocular surgery is not established. Biosecur is a non-toxic organic alcohol-free compound that exhibited bactericidal and fungicidal effect versus all common microorganisms and is currently available as an ocular spray. Keywords: Antisepsis, Disinfectant, Antibiotic resistance, Ocular surgery, Endophthalmitis, Risk management, Public health
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Alfredo Borgia, Daniela Mazzuca, Marcello Della Corte et al.. Prophylaxis of Ocular Infection in the Setting of Intraocular Surgery: Implications for Clinical Practice and Risk Management. Ophthalmology and Therapy. (2023). https://doi.org/10.1007/s40123-023-00661-9 Alfredo Borgia, Daniela Mazzuca, Marcello Della Corte, Nicola Gratteri, Giovanni Fossati, Raffaele Raimondi, Luca Pagano, Vincenzo Scorcia, Giuseppe Giannaccare
1Eye Unit, Humanitas-Gradenigo Hospital, Turin, Italy 2Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool, UK 3Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy 4Department of Law, Forensic Medicine and Criminology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy 5Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy 6Department of Ophthalmology, University “Magna Græcia” of Catanzaro, Viale Europa, 88100 Germaneto, Catanzaro Italy 