Double Povidone-Iodine 5% Preparation Before Cataract Surgery for Endophthalmitis Prevention

To compare endophthalmitis rates after cataract extraction in patients with different preoperative prophylaxis: double povidone-iodine preparation with topical antibiotics versus a control group.

All cases of postoperative endophthalmitis over the last 17 years were reviewed. Incidence rates of endophthalmitis for all cataract surgeries (current procedural terminology codes 66982 and 66984) performed by 26 surgeons were calculated. Cataract surgery combined with glaucoma and corneal procedures were excluded (1,347 surgeries). Incidence rates were compared for the study group (i.e., use of double povidone-iodine preparation) versus the control group. In the study group, two standard interventions were implemented: preoperative instillation of fluoroquinolone drops every 15 min for 1 hr and preoperative irrigation of conjunctival fornices and eyelashes with 10 cc of 5% povidone-iodine. In both the study and control group, povidone-iodine preparation was performed in the operating room, and postoperative fluoroquinolone drops were used.

From January 2005 to May 2022, no cases of endophthalmitis were identified out of 7,611 cataract extractions performed by three surgeons who used the double povidone-iodine preparation. Seven new cases of endophthalmitis were identified in the control group during the same time (7 out of 9,876=0.07%). Two of these cases had combined cataract surgery with endoscopic cyclophotocoagulation, and five cases had cataract surgery alone. Individual surgeon rates of endophthalmitis ranged from 0% to 0.29%.

A double povidone-iodine preparation may provide more robust prophylaxis against postcataract extraction endophthalmitis than a single preparation.