Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery

Abstract

Kazuki Matsuura,1 Takafumi Mori,2 Takeshi Miyamoto,3 Chikako Suto,4 Yusuke Saeki,5 Shigeto Tanaka,6 Hajime Kawamura,7 Shinji Ohkubo,8 Masaki Tanito,9,10 Yoshitsugu Inoue111Nojima Hospital, Kurayoshi, 2Department of Ophthalmology, School of Medicine, Fukushima Medical University, Fukushima, 3Department of Ophthalmology, Wakayama Medical University, Wakayama, 4Department of Ophthalmology, Tokyo Women’s Medical University, Tokyo, 5Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, 6Tonosho Central Hospital, Kagawa, 7Shiga University of Medical Science, Otsu, 8Department of Ophthalmology and Visual Science, Kanazawa University Graduate School of Medical Science, Kanazawa, 9Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, 10Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, 11Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Yonago, JapanPurpose: 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.Conclusion: 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.Keywords: intracameral antibiotic, intraoperative iodine, antibiotic prophylaxis, cataract surgery, endophthalmitis