Preparation of the Ophthalmic Surgery
Comparison of Povidone-Iodine With a Prophylactic Antibiotic
Isenberg, MD; Leonard Apt, MD; Robert Yoshimori, PhD; Steven Khwarg,
\s=b\ We previously found that half\x=req-\ strength (5%) povidone-iodine solution significantly reduced the bacterial flora of the conjunctiva. Tocompare the antibacterial effect of a topical combination antibiotic (Neosporin ophthalmic solution) given three times daily for three days preoperatively with that of half-strength povidone-iodine solution given as part of the preoperative preparation, conjunctival cultures were studied from 35 patients undergoing ocular surgery. When used individually, the antibiotic and povidone\x=req-\
iodinesolutions caused a similar and substantial decrease in the number of colonies and species of bacteria cultured. When both drugs were used together, the decrease was even more striking, making 83% of the conjunctivae sterile. To minimize bacterial flora before ocular surgery, we recommend that a broad-spectrum topical antibiotic be given for three days preoperatively and that half-strengthpovidone-iodine solution be used as part of the preoperative preparation. (Arch Ophthalmol 1985; 103:1340-
Ophthalmology, Harbor-UCLA Medical Center, Torrance, Calif (Drs Isenberg and Yoshimori);
and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles (Drs Isenberg, Apt, and Khwarg). Reprint requests to Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA90024
Accepted for publication April 1, 1985. From the Jules Stein Eye Institute, Division of
imize the incidence of postoperative ocular infections, ophthalmic sur¬ geons have used various strategies. Some have relied totally on preopera¬ tive chemical preparation of the eye to decrease the bacterial flora, while others have depended largely on pro¬ phylactic antibiotic agents applied topicallyhours to days before sur¬ gery.' While there is controversy as to the optimal dosage, frequency, timing, and type of antibiotic, there is general agreement that prophylactic antibiot¬ ics can be effective in reducing the bacterial flora of the conjunctiva.2 In a recent study, we found that when half-strength (5%) povidoneiodine solution was placed in the conjunctival cul-de-sac as part of thepreoperative preparation of the eye, there was a significant decrease in the number of colonies and species of bac¬ teria compared with controls.3 The experimental design of that study excluded cases in which preoperative antibiotics were used. We subsequent¬ ly became interested in comparing the antibacterial effect of an antibiotic agent given topically for several days before surgery with that of5% povi¬ done-iodine solution used as part of the immediate preparation of the eye before surgery. We also decided to study the results of using both antimi¬ crobial measures in the same eye. If povidone-iodine solution proved to be at least as effective as prophylactic
the attempt to prepare a sterile * field for surgery and thus help min¬
thalmic surgery might be spared some of thedisadvantages of using antibi¬ otics: expense, bother, toxic and aller¬ gic effects, and the growth of antibiot¬ ic-resistant microorganisms.
PATIENTS AND METHODS
antibiotics (other than as part of this protocol). No patient had an ocular infec¬ tion at the time of the study. All patients were given a commercially available oph¬ thalmic antibiotic solution consisting of polymyxin B sulfate, neomycinsulfate, and gramicidin (Neosporin ophthalmic solu¬ tion), to use at home on one randomly selected eye three times a day for three days before surgery. An additional drop was given on the morning of surgery. The chosen eye may or may not have been the eye operated on in unilateral surgery. Whether the surgery was to be bilateral or unilateral, both eyes had an identical preoperative chemical...