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Clinical Ophthalmology (Auckland, N.Z.) 2024To evaluate if chloroprocaine ophthalmic gel 3% acts as a barrier to the bactericidal actions of povidone-iodine (PVI) which has been seen in other higher viscosity gel... (Clinical Trial)
Clinical Trial
PURPOSE
To evaluate if chloroprocaine ophthalmic gel 3% acts as a barrier to the bactericidal actions of povidone-iodine (PVI) which has been seen in other higher viscosity gel anesthetics.
METHODS
This was a single site, prospective, randomized, patient-masked study evaluating the effects of preservative-free chloroprocaine ophthalmic gel 3% (IHEEZO, Harrow, Nashville, TN) compared with tetracaine ophthalmic solution 0.5% and their effects on the bactericidal action of povidone-iodine 5%. The study comprised 82 patients who had both eyes cultured before and after application of randomized treatment and povidone-iodine.
RESULTS
In terms of mean percent reduction in colony forming units, chloroprocaine with povidone-iodine was non-inferior to tetracaine with povidone-iodine, with a higher mean percent reduction in colony forming units in the chloroprocaine group (change [∆] = -7.2; 90% CI, -13.56 to 3.28).
CONCLUSION
Data collected in this study suggest that preservative-free chloroprocaine ophthalmic gel 3% does not act as a barrier to the bactericidal actions of povidone-iodine 5% and that the reduction in CFU from PVI is similar when compared with tetracaine 0.5% ophthalmic solution with PVI.
PubMed: 38504931
DOI: 10.2147/OPTH.S454496 -
Ghana Medical Journal Jun 2023the aim was to compare 2 drops of either 5% chloramphenicol, 1% povidone-iodine or 5% povidone-iodine before cataract surgery on reducing the colonisation of bacterial... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
the aim was to compare 2 drops of either 5% chloramphenicol, 1% povidone-iodine or 5% povidone-iodine before cataract surgery on reducing the colonisation of bacterial flora in the conjunctiva.
DESIGN
This was a double-blind, randomised clinical trial study.
SETTING
Patients referred to Shahid Sadoughi Hospital in Yazd, Iran, for cataract surgery were studied.
PARTICIPANTS
Totally 260 patients were enrolled.
INTERVENTION
The affected lower fornix was gently sampled with a sterile swab and cultured on appropriate microbiological media. Then one of the 3 solutions mentioned above was instilled into the conjunctival sac of the cases in groups 1, 2 and 3, respectively. After thirty minutes, new conjunctival swabs were taken and cultured.
MAIN OUTCOME MEASURES
The type of bacteria isolated and their colony-forming unit per mL (CFU/mL) number were primary end-points. The statistical tests of Phi and Cramer's V and Wilcoxon and Kruskal-Wallis were applied to evaluate the relationship between the studied variables and culture results as the secondary end-point.
RESULTS
The studied patients were 129 (49.6%) males and 131 (50.4%) females. Bacterial growth was observed in 49 cases (18.85%); the most commonly isolated bacteria were (71.42%). In the povidone-iodine 5% and chloramphenicol groups (but not the povidone-iodine 1%), the decrease in the number of CFU/mL was statistically significant (P = 0.032 and P = 0.005, respectively, Wilcoxon test).
CONCLUSION
A single dose of povidone-iodine 5% and chloramphenicol effectively reduces the colonisation of normal conjunctival bacteria and can be used as effective prophylaxis.
FUNDING
This study was part of an MSc thesis of Nasrin Tofighi. Shahid Sadoughi University of Medical Sciences, Yazd, Iran, funded this work.
Topics: Male; Female; Humans; Povidone-Iodine; Chloramphenicol; Ophthalmic Solutions; Conjunctiva; Bacteria; Cataract
PubMed: 38504751
DOI: 10.4314/gmj.v57i2.1 -
The Ocular Surface Apr 2024To investigate cytokine levels in the tear fluid of patients receiving serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) for...
PURPOSE
To investigate cytokine levels in the tear fluid of patients receiving serial intravitreal injections (IVI) with anti-vascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD).
METHODS
Concentrations of six cytokines (IFN-γ, IL-1β, IL-6, IL-8, TNF and VEGF) in tears of patients receiving anti-VEGF in one eye were assayed using multiplex cytometric bead array. The fellow untreated eye served as control. Tear sampling was performed on a single occasion at a minimum of four weeks after IVI. Patients underwent a pre-IVI antisepsis protocol with povidone-iodine.
RESULTS
Tear fluid from thirty patients with a mean age of 78.8 years (range 58-90) was assayed. Subjects received a median of 43.5 (range 22-106) IVI in one eye. The median level of IFN-γ was 0.33 (interquartile range (IQR) 0.22-0.52) pg/mg of total protein in injected eyes versus 0.41 (IQR 0.21-1.05) pg/mg in fellow eyes (p = 0.017). For TNF, a median level of 0.12 (IQR 0.08-0.18) pg/mg of total protein was found in injected eyes versus 0.14 (IQR 0.07-0.33) pg/mg of total protein in fellow eyes (p = 0.019). There were no differences between injected and fellow eyes regarding the levels of IL-1β, IL-6, IL-8 and VEGF.
CONCLUSION
Tear fluid in eyes receiving serial IVI with anti-VEGF and preoperative povidone-iodine antisepsis constitutes lower levels of the pro-inflammatory cytokines IFN-γ and TNF compared to fellow eyes. This provides biochemical support of previous findings of reduced signs of inflammation and healthier tear film parameters in patients treated with serial IVI.
Topics: Humans; Tears; Intravitreal Injections; Aged; Cytokines; Male; Female; Middle Aged; Aged, 80 and over; Angiogenesis Inhibitors; Vascular Endothelial Growth Factor A; Ranibizumab; Wet Macular Degeneration; Prospective Studies
PubMed: 38490478
DOI: 10.1016/j.jtos.2024.03.004 -
Journal of Cataract and Refractive... Jul 2024To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
PURPOSE
To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium.
SETTING
Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.
DESIGN
Prospective, randomized, double-blind study.
METHODS
Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system.
RESULTS
The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application ( P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI ( P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application ( P < .001).
CONCLUSIONS
Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.
Topics: Humans; Povidone-Iodine; Prospective Studies; Double-Blind Method; Anti-Infective Agents, Local; Female; Male; Middle Aged; Aged; Colony Count, Microbial; Bacteria; Conjunctiva; Epithelium, Corneal; Eye Infections, Bacterial; Adult
PubMed: 38477800
DOI: 10.1097/j.jcrs.0000000000001436 -
Journal of the American Academy of... Jul 2024
Topics: Humans; Povidone-Iodine; Anti-Infective Agents, Local; Gels; Ultrasonography, Interventional; Female; Male
PubMed: 38467305
DOI: 10.1016/j.jaad.2024.01.087 -
Annals of Gastroenterological Surgery Mar 2024Antiseptics used at surgical sites are vital to preventing surgical site infections (SSI). In this study, a comparative investigation of the novel antiseptics...
AIM
Antiseptics used at surgical sites are vital to preventing surgical site infections (SSI). In this study, a comparative investigation of the novel antiseptics olanexidine gluconate (OG) and povidone-iodine (PI) was conducted to determine whether OG is more effective than PI against SSI after gastrointestinal surgery.
METHODS
This prospective, randomized, single-blind, interventional, single-center study was conducted between August 2018 and February 2021. Patients scheduled for large-scale gastrointestinal surgeries were randomized into two groups and administered OG (OG group) or PI (PI group) as preoperative antiseptics. The primary endpoint was the SSI occurrence rate within 30 days after surgery.
RESULTS
In total, 525 patients were enrolled in this study, of whom 256 and 254 were in the OG and PI groups, respectively. The total SSI occurrence rate in the OG group (10.8%; = 26) and the PI group (13.0%; = 33) was not significantly different ( = 0.335). The occurrence rate of superficial incisional SSI and organ/space SSI did not significantly differ between the groups; however, that of deep incisional SSI showed a significant difference, with 0.4% ( = 1) in the OG group and 4.3% ( = 11) in the PI group ( = 0.003).
CONCLUSION
OG, as a preoperative skin antiseptic, did not reduce the occurrence rate of total SSI. However, deep incisional SSI may be reduced using OG.
PubMed: 38455490
DOI: 10.1002/ags3.12739 -
Case Reports in Veterinary Medicine 2024An adult male black horse was presented to the UOG veterinary clinic with swelling, discharge, and skin wounds on the chest wall and the right front leg; then, it goes...
An adult male black horse was presented to the UOG veterinary clinic with swelling, discharge, and skin wounds on the chest wall and the right front leg; then, it goes to the lateral and medial hind leg. Inspection and palpation were carried out, and we revealed that the skin was swelled, thickened and hard on clinical examination. There was also nodule rupture, and discharge on the limb and chest skin. Different therapy was applied starting from washing the wound with water-diluted potassium permanganate and then 0.9% NaCl together with paraffin topically placed on the wound. 10% povidone-iodine was also applied by using gauze. Griseofulvin 750 mg/day for one week was given as antifungal therapy orally. The prognosis was poor due to the long incubation period and high resistance of the causative agent.
PubMed: 38444552
DOI: 10.1155/2024/2478774 -
Retinal Cases & Brief Reports Mar 2024To present a novel case of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection.
PURPOSE
To present a novel case of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection.
METHODS
Case report.
RESULTS
A 74-year-old male presented with acute progressive vision loss and pain in the left eye, 5 days after an intravitreal injection for diabetic macular edema. The patient was diagnosed with exogenous endophthalmitis and empirically treated with intravitreal injections of vancomycin and ceftazidime as well as topical and oral ciprofloxacin. In follow up two days later, the patient was treated with preoperative povidone-iodine followed by prompt vitrectomy with additional vancomycin and ceftazidime due to pharmacy sterile hood issues that delayed antibiotic availability. Microbiological cultures and two mass spectrometry identification tests confirmed the diagnosis of exogenous Rahnella aquatilis endophthalmitis. Despite the presence of scattered retinal hemorrhagic infarcts involving the macula and subsequent full-thickness atrophic macular holes seen in follow up, the patient achieved a favorable anatomical and functional outcome of BCVA 20/80 at 1 year of follow-up.
CONCLUSION
This case highlights the occurrence of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection for diabetic macular edema. Prompt diagnosis and treatment produced a favorable outcome relative to other typical Gram-negative Enterobacteriaceae organisms.
PubMed: 38437795
DOI: 10.1097/ICB.0000000000001567 -
Cureus Feb 2024Introduction Diluted Betadine (Purdue Pharma, Stamford, Conn) irrigation following primary total joint arthroplasty (pTJA) may reduce the risk of periprosthetic joint...
Introduction Diluted Betadine (Purdue Pharma, Stamford, Conn) irrigation following primary total joint arthroplasty (pTJA) may reduce the risk of periprosthetic joint infection (PJI). A recent study found a minimal inhibitory concentration (MIC) of 0.63% Povidone-iodine (Betadine) for several bacterial isolates. This study reports outcomes of patients undergoing TJA using 0.54% Betadine irrigation compared to a historical cohort using 0.3% Betadine irrigation. Methods A retrospective chart review of patients who underwent pTJA from September 2017 to December 2020. 0.3% Betadine was used in a historical cohort and 0.54% Betadine in the experimental group. Patient demographics, intra-operative data, all-cause revision, and infection data were collected for the three-month post-operative period. Outcome frequencies between groups were compared using Fisher-Exact tests. Results Six hundred sixty-one patients underwent pTJA: 308 total knee arthroplasty (TKA), and 353 total hip arthroplasty (THA). 0.3% Betadine group had seven (3.1%) revisions: five (2.2%) underwent a revision for non-infectious reasons, and two (0.9%) for PJI. 0.54% Betadine group had 11 (2.5%) revisions: nine (2.1%) underwent revision for non-infectious reasons, two (0.4%) for PJI. No significant difference was found for rates of all-cause revision or infection between groups. No adverse intra-operative events occurred with the higher Betadine concentration. Conclusion This study demonstrated no difference in rates of all-cause revision or PJI when using 0.3% Betadine versus 0.54% Betadine for irrigation following pTJA. No adverse intraoperative events occurred with 0.54% Betadine irrigation. Given recent data supporting increased Betadine MIC, our results showed safety and non-inferiority with respect to three-month post-operative complication rates. Further investigation through a large powered randomized controlled study is needed to determine the optimal Betadine irrigation concentration for PJI prevention is required.
PubMed: 38435161
DOI: 10.7759/cureus.53453 -
Cureus Feb 2024Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of...
Efficacy of Hydrocortisone, Povidone-Iodine, and Normal Saline as an Irrigating Solution During Surgical Removal of Impacted Mandibular Third Molars: A Randomized Controlled Trial.
Background The surgical removal of mandibular third molars is one of the most common procedures in dentistry. Researchers have extensively studied the treatment of postoperative sequelae such as pain, edema, trismus, and alveolar osteitis throughout the past six decades. Many approaches have been used to address clinical difficulties after third molar surgery, including various flap designs and irrigating solutions. The aim of this study was to compare the effects of three irrigating solutions, hydrocortisone, povidone-iodine, and normal saline, on pain, trismus, and edema following surgical removal of the impacted mandibular third molar. Methodology The study involved 105 participants who required surgical extraction of mandibular third molars. The patients' ages ranged from 18 to 40 years, and they fulfilled the inclusion criteria. Using a simple random sampling technique, they were divided into three groups (group 1: hydrocortisone, group 2: povidone-iodine, group 3: normal saline). The parameters evaluated were edema, pain, and trismus on the second and seventh postoperative days. All data were input into Microsoft Excel (Microsoft Corp., Redmond, USA) worksheets and analyzed using Stata 17.0 (StataCorp LLC, College Station, USA). The visual analog scale (VAS) score was used to measure postoperative pain, and postoperative swelling was measured using linear measurements from four fixed anatomical points and compared to preoperative values. To assess trismus, the inter-incisal distance was measured in millimeters with a caliper. A p-value of <0.01 was considered statistically significant. Results The mean VAS score for pain in group 1 was lower than the other two groups. The effect of group 1 was significant on the second postoperative day but insignificant on the seventh postoperative day for swelling. The effect of all three groups on trismus was significant on the second and seventh days. Conclusions Hydrocortisone as an irrigating solution showed promising results in managing postoperative swelling in the first 48 hours, but its effect gradually declined by the seventh postoperative day. Additionally, it was effective in controlling postoperative pain and trismus. This suggests that utilizing hydrocortisone as an irrigating solution, compared to povidone-iodine, has been proven to be a significantly effective option in reducing postoperative pain, edema, and trismus resulting from the surgical removal of impacted teeth.
PubMed: 38435159
DOI: 10.7759/cureus.53370