Endophthalmitis is the most dreaded complication of cataract (or any other intraocular) surgery. Even when it's diagnosed and treated immediately and appropriately, the risk of vision loss is high. Fortunately, the post-operative inflammatory reaction is extremely rare, but not so rare that we can allow ourselves to be overconfident or fail to do everything in our power to prevent it. Research is ongoing, and new theories are emerging, but the best current path to prevention involves a combination of old-school knowledge and discipline, and new-school technology. Here's how to steer clear of one of the most devastating diagnoses in ophthalmology.
1. Povidoneiodine is proven effective. Most ophthalmologists agree that the most effective preventive measure against endophthalmitis is to use a povidone-iodine product both in the eye, and also as a prep around the eye. In fact, cleaning the surgical site with povidone-iodine is the only technique scientifically proven to reduce the risk of endophthalmitis after intraocular surgeries (osmag.net/fqbh8x).
We have 9 surgeons who operate at our facility and although there's some slight variation in timing some administer povidone-iodine in the pre-op area, some in the OR all use it, and generally within 5 minutes before starting the procedure.
Because it's so important as a prophylactic measure, if patients tell us they're allergic to iodine, we make sure there's no confusion. Patients may think they're allergic because they've had injections of iodinated contrast material for an intravenous pyelogram or are allergic to shellfish. But that particular sensitivity doesn't necessarily mean they're allergic to topical iodine, so we administer a skin test. On those rare occasions when patients turn out to be allergic, we use a product that contains a small amount of hypochlorous acid.