Risk of endophthalmitis after cataract surgery using different protocols for povidone-iodine preoperative disinfection

Aims: The aim of this study was to assess the risk of postoperative endophthalmitis associated with different prophylactic protocols, using povidone-iodine disinfection of the skin and conjunctiva in patients undergoing cataract surgery over an 8-year period at Chang Gung Memorial Hospital (Kaohsiung, Taiwan). Method: This was a retrospective, comparative, case-controlled study. Data were collected on patients who received different prophylactic disinfection protocols prior to extracapsular cataract extraction with intraocular lens implantation between January 1992 and January 2000. Possible risk factors for the occurrence of postoperative endophthalmitis were analyzed. Results: Medical charts for a total of 10,614 extracapsular cataract extraction surgeries performed during the 8-year period were reviewed, and 12 eyes that developed postoperative endophthalmitis were identified and analyzed. Another 120 eyes matched for age and gender of the patient were randomly selected as controls. Skin preparation with 5% povidone-iodine was associated with an increased risk of postoperative infection, compared to that of 10% povidone-iodine. On the conjunctiva, a lack of 5% povidone-iodine disinfection was associated with an increased risk of postoperative infection, compared to 5% povidone-iodine disinfection. Conclusions: Preoperative skin disinfection with 10% povidone-iodine and conjunctival disinfection with 5% povidone-iodine significantly reduced the relative risk of postoperative endophthalmitis.