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Antimicrobials and antiseptics: Lowering effect on ocular surface bacterial flora - A systematic review

Mariantonia Ferrara1, Francesca Gatti2,3, David Lockington4

  • 1Manchester Royal Eye Hospital, Manchester, UK.

Acta Ophthalmologica
|July 10, 2023
PubMed

Insights

Topical antiseptics effectively reduce ocular surface bacteria before eye surgery. Perioperative antimicrobials are not recommended due to resistance risks, but may be used post-operatively for high-risk infections.

Area of Science:

  • Ophthalmology
  • Microbiology
  • Infectious Diseases

Background:

  • Post-operative infectious complications following ocular surgeries like cataract surgery and intravitreal injections (IVI) are a significant concern.
  • Topical antimicrobials and antiseptics are commonly used perioperatively to reduce ocular surface bacteria flora (OSBF), but their efficacy remains debated.

Approach:

  • This systematic review followed PRISMA guidelines and was registered in PROSPERO.
  • It evaluated the efficacy of perioperative topical agents in reducing OSBF for cataract surgery and IVI.
  • The review analyzed evidence regarding antimicrobial resistance and comparative benefits of antiseptics versus antimicrobials.

Key Points:

  • Perioperative topical antimicrobials can lower OSBF but carry a risk of resistance development without clear added benefit over antiseptics.
  • Topical antiseptics demonstrate strong evidence of effectiveness in reducing OSBF prior to cataract surgery and IVI.
  • The use of perioperative antimicrobials is not recommended based on current evidence.

Conclusions:

  • Perioperative antiseptic use is strongly recommended as a prophylactic measure against infections stemming from OSBF.
  • Post-operative antimicrobial use may be considered for patients with a higher risk of developing ocular infections.
  • Further research may be needed to fully elucidate the long-term impact of perioperative antimicrobial use and resistance patterns.
Keywords:
cataract surgeryintravitreal injectionsocular surface bacterial floratopical antimicrobialstopical antiseptics

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