Koederitz N Marie, Neely Daniel E, Plager David A, Boehmer Blair, Ofner Susan, Sprunger Derek T, Sondhi Naval, Roberts Gavin
Indiana University School of Medicine/Riley Children's Hospital, Indianapolis, Indiana, USA.
J AAPOS. 2008 Aug;12(4):396-400. doi: 10.1016/j.jaapos.2007.10.005. Epub 2007 Dec 26.
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.
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.
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.
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.
虽然斜视手术后第一周通常会使用抗生素/类固醇组合药物，但它们成本高昂且使用不便，可能并无必要。本研究比较了单剂量5%聚维酮碘滴眼液与为期一周的抗生素/类固醇疗程在眼外肌手术中预防术后感染的效果。
对1871例行常规斜视手术的患者进行回顾性病历审查。患者在手术结束时，接受了一次向手术眼应用5%聚维酮碘溶液，或为期一周的局部抗生素/类固醇疗程。然后审查术后记录，以确定术后头2个月内出现的异常或并发症。
发现1603例患者有完整记录。953例（59.5%）采用单剂量聚维酮碘预防，650例（40.5%）采用术后局部抗生素/类固醇组合疗程。在这1603例病例中，46例（2.87%）可能发生感染。在这46例可能的感染中，650例接受抗生素/类固醇组合治疗的患者中有20例（3.08%）发生感染，953例接受单剂量聚维酮碘预防治疗的患者中有26例（2.83%）发生感染。这种差异无统计学意义（p = 0.6815）。两组均未发生眼眶蜂窝织炎或眼内炎病例。
对于通过穹窿切口进行的常规斜视手术，单剂量聚维酮碘是术后抗生素/类固醇预防的一种廉价替代方法。接受再次手术和角膜缘切口的患者术后病程更可能复杂：在这些组中使用抗生素/类固醇可能有益。
