Trinavarat Adisak, Atchaneeyasakul La-ongsri, Nopmaneejumruslers Cherdchai, Inson Kantima
Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Dermatology. 2006;212 Suppl 1:35-40. doi: 10.1159/000089197.
Postoperative endophthalmitis reflects in part quality and safety aspects of cataract surgery. Preoperative 5% povidone-iodine was introduced as a quality improvement effort. This study evaluated the effect of this additional measure on the occurrence of endophthalmitis after cataract surgery.
Topical 5% povidone-iodine solution was applied onto the ocular surface just prior to transferring the patient into the operative theater for cataract surgery. Other prophylactic measures were allowed to continue as before. Patients developing postoperative intraocular inflammation and undergoing intravitreal antibiotic injection were included as occurrences of endophthalmitis. Alteration in endophthalmitis rate was analyzed using a 'p control chart' of a statistical process control method. The incidence in the povidone-iodine-receiving group was compared to those before implementation and concurrent nonreceiving groups.
The postoperative endophthalmitis rate showed a significant reduction after introduction of povidone-iodine. A year before, 9 of 3,052 eyes developed endophthalmitis (0.294%). After introduction, this occurred in 4 of 4,089 eyes receiving povidone-iodine (0.097%) and 1 of 502 nonreceiving eyes (0.199%) in the following 16 months. Despite the apparent lower rate, comparison between groups was not statistically significant. Moderate to severe but tolerable eye irritation after application was reported in 6.6%. No other adverse events were detected.
Topical preoperative 5% povidone-iodine contributed an additional effect to the reduction of the postoperative endophthalmitis rate after cataract surgery. This measure was rather safe to apply as a prophylaxis against endophthalmitis in cataract surgery.
术后眼内炎部分反映了白内障手术的质量和安全方面。引入术前5%聚维酮碘作为一项质量改进措施。本研究评估了这一额外措施对白内障手术后眼内炎发生情况的影响。
在将患者转入白内障手术手术室之前，将局部用5%聚维酮碘溶液应用于眼表。其他预防措施如前继续使用。将发生术后眼内炎症并接受玻璃体内抗生素注射的患者作为眼内炎病例纳入。使用统计过程控制方法的“p控制图”分析眼内炎发生率的变化。将接受聚维酮碘组的发生率与实施前组和同期未接受组的发生率进行比较。
引入聚维酮碘后，术后眼内炎发生率显著降低。一年前，3052只眼中有9只发生眼内炎（0.294%）。引入后，在接下来的16个月中，接受聚维酮碘的4089只眼中有4只发生眼内炎（0.097%），未接受的502只眼中有1只发生眼内炎（0.199%）。尽管发生率明显较低，但组间比较无统计学意义。报告有6.6%的患者在应用后出现中度至重度但可耐受的眼部刺激。未检测到其他不良事件。
术前局部应用5%聚维酮碘对降低白内障手术后的术后眼内炎发生率有额外作用。作为白内障手术中预防眼内炎的措施，该方法应用起来相当安全。
