Safar Ammar, Dellimore Monica C
Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 523, Little Rock, AR 72205, USA.
Int Ophthalmol. 2007 Oct;27(5):307-12. doi: 10.1007/s10792-007-9073-6. Epub 2007 Apr 18.
To determine the most effective method of applying povidone iodine 5% to decrease conjunctival colonization before intravitreal injections.
Twenty-eight patients from two tertiary care centers undergoing intravitreal injection for diffuse diabetic macular edema, exudative age-related macular degeneration, venous occlusive disease, or refractory pseudophakic cystoid macular edema were prospectively randomized to two study arms. One arm received 2-3 drops of 5% povidone iodine (drops group) and the second received a 10 ml flush of the same solution (flush group). The inferior conjunctival fornix was cultured before and after antiseptic technique was performed in all patients. Three culture media, thioglycollate broth, chocolate agar and blood agar, were used for each sample.
Each study group had 14 patients. Prior to antisepsis, 22 of the 28 (78.6%) subjects had positive conjunctival cultures. 16 and 14 bacterial organisms were isolated in the first and second groups, respectively. After using 2-3 drops of 5% povidone iodine in the first study arm of patients, three of 16 (18.7% reduction) bacterial organisms were no longer isolated in thioglycollate broth media. With flush irrigation of 10 ml of 5% povidone iodine, seven of 14 (50% reduction) bacterial organisms were no longer isolated (P-value 0.07) in broth media. No difference in reduction of bacterial colonization was found on plated media (chocolate agar and blood agar).
Irrigating the conjunctival fornix with 5% povidone iodine results in greater reduction of bacterial colonization compared with drop application of the same solution. Flush irrigation may provide better protection against the risk of endophthalmitis with intravitreal injections.
确定应用5%聚维酮碘以减少玻璃体内注射前结膜定植的最有效方法。
来自两个三级医疗中心的28例因糖尿病性黄斑水肿、渗出性年龄相关性黄斑变性、静脉阻塞性疾病或难治性人工晶状体眼黄斑囊样水肿而接受玻璃体内注射的患者被前瞻性随机分为两个研究组。一组接受2 - 3滴5%聚维酮碘（滴眼组），另一组接受10 ml相同溶液冲洗（冲洗组）。对所有患者在进行消毒技术前后对结膜下穹窿进行培养。每个样本使用三种培养基，即硫乙醇酸盐肉汤、巧克力琼脂和血琼脂。
每个研究组有14例患者。在消毒前，28例受试者中有22例（78.6%）结膜培养阳性。第一组和第二组分别分离出16种和14种细菌。在第一研究组患者中使用2 - 3滴5%聚维酮碘后[1]，硫乙醇酸盐肉汤培养基中16种细菌中有3种（减少18.7%）不再被分离出。用10 ml 5%聚维酮碘冲洗后，14种细菌中有7种（减少50%）在肉汤培养基中不再被分离出（P值0.07）。在平板培养基（巧克力琼脂和血琼脂）上细菌定植减少情况无差异。
与滴用相同溶液相比，用5%聚维酮碘冲洗结膜下穹窿可使细菌定植减少更多。冲洗可能为玻璃体内注射提供更好的预防眼内炎风险的保护。
[1] 此处原文存在一处错误，“After using 2-3 drops of 5% povidone iodine in the first study arm of patients”应改为“After using 2-3 drops of 5% povidone iodine in the first study group of patients” ，翻译时按照正确内容进行了翻译。
