Reduction of Anterior Chamber Contamination Rate After Cataract Surgery by Intraoperative Surface Irrigation With 0.25% Povidone-Iodine

PURPOSE: To prove the hypothesis that during cataract surgery, repeated irrigation of the operative field with povidone iodine of 0.25% reduces the anterior chamber bacterial contamination rate at completion of operation. DESIGN: Prospective, interventional case series. METHODS: In 404 consecutive eyes, the operative field was irrigated with infusion fluid in 202 eyes (group A) and with 0.25% povidone iodine in 202 eyes (group B). Bacteriologic culture was performed using the following samples: ocular surface fluid after lid speculum placement and anterior chamber fluid at the completion of surgery. Anterior chamber fluid samples were collected at the beginning and completion of surgery for iodide ion concentration measurement. Corneal endothelial cell density was measured using a specular microscope before surgery and on day 7 after surgery. RESULTS: Bacterial detection rate in ocular surface fluid was not significantly different between group A (5.5%) and group B (6.0%), but the rate in anterior chamber fluid was significantly (P = .0017) reduced in group B (0%) compared with group A (5.0%). Iodide ion concentrations at the start and end of surgery were 7.5 +/- 0.7 mu g/mL and 3.5 +/- 0.7 mu g/mL, respectively, in group B and less than 0.1 mu g/mL both at the start and end of surgery in group A. Corneal endothelial cell densities were not significantly difference between groups A and B before surgery (2614 +/- 233/mm(2) vs 2534 +/- 173/mm(2); P = .2254) and 7 days after surgery (2463 +/- 269/mm(2) vs 2338 +/- 204/mm(2); P = .4044). CONCLUSIONS: In cataract surgery, repeated irrigation of the operative field with povidone iodine at a concentration of 0.25% achieved an extremely low bacterial contamination rate in the anterior chamber at the completion of surgery. (Am J Ophthalmol 2011;151: 11-17. (c) 2011 by Elsevier Inc. All rights reserved.)