Paediatric Strabismus Surgery: a Retrospective Analysis of Different Postoperative Treatment Regimes to Prevent...

BACKGROUND: Povidone iodine (PVI) has been reported to surpass topical antibiotics in antibacterial effectiveness. Consequently, we changed the regimen post strabismus surgery in 2017 from a one-week course of topical antibiotic eye drops to PVI given once at the end of surgery. In an adult population, this resulted in no significant change in infection rate and healing. In paediatric patients, the immune system is not mature and children may be exposed to different pathogens. Therefore, the aim of this study was to evaluate these two regimens in regard to their efficacy to prevent infections post strabismus surgery in children.

PATIENTS AND METHODS: In this retrospective and exploratory study, data from paediatric patients with strabismus surgery before and after this change in postoperative treatment were analysed. Information was taken from routine follow-up visits on postoperative days 7 and at 3 months. Primary endpoint was the postoperative incidence of bacterial conjunctivitis. Secondary endpoints were conjunctival swelling and redness, corneal wound healing and presence of cells in the anterior chamber or vitreous body. Statistical analysis was performed using Fisher's exact test or the Mann-Whitney U test. p < 0.05 was considered significant.

RESULTS: 152 patients were included. 85 children (G1) had received aminoglycoside eye drops 3×/day for 1 week following strabismus surgery and 67 children (G2) had received a single-dose of topical PVI immediately at the end of surgery. Average age in G1 was 8.2 (SD 4.5; range 1 - 17) years and in G2 was 7.4 (SD 3.9; range 2 - 17) years. There was no statistically significant difference in the surgical procedure performed (type of surgery, reoperations, duration of the surgery). Bacterial conjunctivitis was documented in 4.7% in G1 and 2.9% in G2 (p > 0.05). There was also no significant difference for any of the secondary endpoints analysed at any of the two regular follow-up dates.

CONCLUSIONS: Postoperative infection prophylaxis with a single administration of topical PVI is an efficient alternative to topical antibiotics in a paediatric population, without more frequent infections or longer healing. This cost-efficient alternative minimises development of resistance to antibiotics and puts less burden on parents and children, as less treatment needs to be applied.