Best phaco disinfection techniques

Three-day application of levofloxacin in the presence of polyvinyl alcohol-iodine or povidone iodine offers the best infection control in phaco patients, according to a study published in the May 2008 issue of the Japanese Journal of Ophthalmology.

Yoshitsugu Inoue of the Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University Yonago, Tottori, Japan and colleagues assessed preoperative disinfection methods to determine which method encouraged optimal duration of levofloxacin (LVFX), comparing povidone-iodine (PI) solution with polyvinyl alcohol-iodine (PAI), in elderly patients undergoing phacoemulsification aspiration and intraocular lens (IOL) implantation (n=272).

Subjects were randomized into six groups: three groups received three-day, one-day and one-hour preoperative applications of LVFX with PI eye wash, respectively; the remaining three groups received three-day, one-day and one-hour preoperative applications of LVFX with PAI eye wash, respectively. Subjects' corneas were scraped before and after LVFX application, after eyewash application and after surgery. Aqueous humour samples were also collected postoperatively.

The researchers found that, across all groups, three-day LVFX application was the more effective disinfectant method and PAI had a marginally higher rate of disinfection than PI: 79.4% and 78.0%, respectively. After LVFX and PAI/PI application, however, new isolates were detected.

The team concluded that, preoperatively, the best disinfection method is three-day application of LVFX with either PAI or PI solution, although it is unlikely that these disinfectants will eliminate bacteria entirely.