Postoperative povidone-iodine prophylaxis in strabismus surgery

• Published in: Journal of AAPOS Vol. 12; no. 4; pp. 396 - 400
• Main Authors: Koederitz, N. Marie, MD, Neely, Daniel E., MD, Plager, David A., MD, Boehmer, Blair, BS, Ofner, Susan, MS, Sprunger, Derek T., MD, Sondhi, Naval, MD, Roberts, Gavin, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2008
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Infective Agents, Local - administration & dosage; Child; Child, Preschool; Dexamethasone - administration & dosage; Drug Therapy, Combination; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Incidence; Infant; Middle Aged; Ophthalmic Solutions; Ophthalmologic Surgical Procedures - methods; Ophthalmology; Postoperative Care - methods; Povidone-Iodine - administration & dosage; Retrospective Studies; Strabismus - surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Tobramycin - administration & dosage; Treatment Outcome; Young Adult
• ISSN: 1091-8531; 1528-3933
• DOI: 10.1016/j.jaapos.2007.10.005

Purpose While antibiotic/steroid combinations are routinely administered during the first week after strabismus surgery, they can be costly and inconvenient and may be unnecessary. This study compares the use of single-dose 5% povidone-iodine drops versus a week-long course of antibiotic/steroid as a prophylaxis against postoperative infection in extraocular muscle surgery. Methods Retrospective chart review was performed of 1871 patients undergoing routine strabismus surgery. Patients received either a single application of 5% povidone-iodine solution to the operative eye(s) at the conclusion of the surgical procedure or a week-long course of topical antibiotic/steroid. Postoperative records were then reviewed to identify abnormalities or complications occurring during the first 2 months after surgery. Results Complete documentation was found for 1603 patients. Single-dose povidone-iodine prophylaxis was used in 953 cases (59.5%), and a postoperative course of topical antibiotic/steroid combination was used in 650 cases (40.5%). Of the 1603 cases, possible infection occurred in 46 patients (2.87%). Of the 46 possible infections, 20 (3.08%) occurred in 650 patients on an antibiotic/steroid combination and 26 (2.83%) occurred in the 953 patients treated with single-dose povidone-iodine prophylaxis. This difference was not statistically significant ( p = 0.6815). No cases of orbital cellulitis or endophthalmitis occurred in either group. Conclusions Single-dose povidone-iodine is an inexpensive alternative to postoperative antibiotic/steroid prophylaxis following routine strabismus surgery performed through a fornix incision. Patients who had reoperations and limbal incisions were more likely to have complicated postoperative courses: antibiotic/steroid use in these groups may be beneficial.