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An Evaluation of Saline Irrigation and Comparison of Povidone-Iodine and Antibiotic in the Surface Decontamination of Donor Eyes

An Evaluation of Saline Irrigation and Comparison of Povidone-Iodine and Antibiotic in the... Abstract • We evaluated the effect of saline irrigation on 38 pairs of donor eyes and determined the relative efficacy of antibiotic rinse/storage (neomycin-polymyxin B-gramicidin) and povidone-iodine immersion. Microbial growth was found in 49 (64.5%) of 76 eyes from which cultures were taken before irrigation, and only four (8.2%) became culture negative after irrigation. Of 27 eyes culture negative before irrigation, 15 (55.6%) became positive after irrigation. One eye of each pair was then assigned randomly to antibiotic rinse/storage and the other eye to 3-minute immersion in 1% povidone-iodine. Both antimicrobial treatments decreased the numbers of positive cultures, with povidone-iodine showing an advantage that did not reach significance. These results demonstrate that saline irrigation of donor eyes in situ does not reduce surface contamination and that povidone-iodine immersion should be considered as an alternative for donor eve decontamination. References 1. Pardos GJ, Gallagher MA. Microbial contamination of donor eyes, a retrospective study . Arch Ophthalmol . 1982;100:1611-1613.Crossref 2. Leveille AS, Dickinson M, Cavanaugh HD. Endophthalmitis following penetrating keratoplasty . Ophthalmology . 1983;90:38-39.Crossref 3. Paton R. Keratoplasty . New York, NY: McGraw-Hill International Book Co; 1958. 4. Rollins MJ, Stocker FW. Bacterial flora and preoperative treatment of donor corneas . Am J Ophthalmol . 1965;59:247-249. 5. Polack FM, Locathcher-Khorazo D, Gutierrez E. Bacteriologic study of 'donor' eyes, evaluation of antibacterial treatments prior to corneal grafting . Arch Ophthalmol . 1967;78:219-225.Crossref 6. Mascarella K, Cavanaugh HD. Penetrating keratoplasty using McCarey-Kaufman preserved corneal tissue . South Med J . 1979;72:1268-1271.Crossref 7. Mathers WD, Lemp MA. Corneal rim cultures . Cornea . 1987;6:231-233.Crossref 8. Larson EL. APIC guidelines for infection control practice: guidelines for use of topical antimicrobial agents . Am J Infect Control . 1988;16:253-266.Crossref 9. Connel JF, Rousselot LM. Povidone-iodine: extensive surgical evaluation of a new antiseptic agent . Am J Surg . 1964;108:849-855.Crossref 10. Wille H. Assessment of possible toxic effects of polyvinyl pyrrolidone-iodine upon the human eye in conjunction with cataract extraction: an endothelial specular microscope study . Acta Ophthalmol . 1986;60:955-960.Crossref 11. Klic F, Boge-Rasmussen I, Jenson OL. The effect of polyvinylpyrrolidone-iodine as an disinfectant in eye surgery . Acta Ophthalmol . 1986;64:67-71. 12. Mindrup FA, Skelnik DL, Albert DL, Lindstrom RL, Doughman DJ. A comparative study of the use of P-I and gentamicin in the decontamination of human donor globes . Invest Ophthalmol Vis Sci . 1985;26( (suppl) ):39. Abstract. 13. White JH. Fungal contamination of donor eyes . Br J Ophthalmol . 1969;53:30-33.Crossref 14. LeFrancois M, Baum JL. Flavobacterium endophthalmitis following keratoplasty . Arch Ophthalmol . 1976;94:1907-1909.Crossref 15. Shaw EL, Aquavella JV. Pneumococcal endophthalmitis following grafting of corneal tissue from a (cadaver) kidney donor . Ann Ophthalmol . 1977;9:435-440. 16. Larsen PA, Lindstrom RL, Doughman DJ. Torulopsis glabrata endophthalmitis after keratoplasty with an organ-cultured cornea . Arch Ophthalmol . 1978;96:1019-1022.Crossref 17. Beyt BE, Waltman SR. Cryptococcal endophthalmitis after corneal transplantation . N Engl J Med . 1978;298:825-826.Crossref 18. Escapini H, Olson RJ, Kaufman HE. Donor cornea contamination with McCarey-Kaufman medium preservation . Am J Ophthalmol . 1980;88:59-62. 19. Khodadoust AA, Franklin RM. Transfer of bacterial infection by donor cornea in penetrating keratoplasty . Am J Ophthalmol . 1979;87:130-132. 20. Guss RG, Koenig S, DeLaPena W, Marx M, Kaufman ME. Endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1983;95:651-658. 21. Jones S, Cohen EJ, Arentsen JS, Laibson PR. Ocular streptococcal infections . Cornea . 1988;7:295-299.Crossref 22. Baer JC, Nirankari VS, Glaros DS. Streptococcal endophthalmitis from contaminated donor corneas after keratoplasty: clinical and laboratory investigations . Arch Ophthalmol . 1988;106:517-520.Crossref 23. Lindquist TD, Weber K, Spika J, Facklam R. Gentamicin-resistant streptococcal endophthalmitis after keratoplasty . Cornea . 1990;9:88-89. 24. Yau CW, Bosin M, Avni I, Kaufman HE. Antibacterial effect of donor corneas stored in gentamicin-enriched McCarey-Kaufman medium . Arch Ophthalmol . 1986;104:263-265.Crossref 25. Goldman KN, Centifonto Y, Kaufman HE, Sloppey TE. Prevention of surface bacterial contamination of donor corneas . Arch Ophthalmol . 1978;96:2277-2280.Crossref 26. Isenberg S, Apt L, Yoshimuri R. Chemical preparation of the eye in ophthalmic surgery, I: effect of conjunctival irrigation . Arch Ophthalmol . 1983;101:761-763.Crossref 27. Harvey SC. Antiseptics and disinfectants; fungicides; ectaparasiticides . In: Gilman AG, Goodman LS, Gilman AF, eds. The Pharmacological Basis of Therapeutics . 6th ed. New York, NY: Macmillan Publishing Co Inc; 1980:973. 28. Truman JR. The halogens . In: Hugo WR, ed. Inhibition and Destruction of the Microbial Cell . London, England: Academic Press Inc; 1971:183-196. 29. Gottardi W. Iodine and iodine compounds . In: Block SS, ed. Disinfection, Sterilization, and Preservation . 3rd ed. Philadelphia, Pa: Lea & Febiger; 1983:183-196. 30. Benevento WJ, Hurray P, Reed AR, Peposa JS. The sensitivity of Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex type II to disinfection with povidone-iodine . Ophthalmology . 1990;19:329-333. 31. Plorkin SA. The effect of povidone-iodine on several viruses . In: Polk HC, Ehrenkranz N, eds. Therapeutic Advances and New Clinical Implications: Medical and Surgical Antisepsis With Betadine Microbicides . Coral Gables, Fla: Purdue Frederick Co; 1972. 32. Harbison MA, Hammer SM. Inactivation of human immunodeficiency virus by Betadine products and chlorhexidine . J AIDS . 1989;2:16-20. 33. Marks LS, McDougal JS, Laskoski SL. Disinfection and inactivation of human immunodeficiency virus by Betadine . Infect Control . 1987;8:412-414. 34. Durno AG, Kaplan JC, Schooley RT. Inactivation of human immunodeficiency virus by povidone-iodine . In: Digenis GA, Agha BJ, Ansel J, Blecher L, eds. Proceedings of the Second International Symposium on Povidone . Lexington, Ky: Kentucky College of Pharmacy, University of Kentucky; 1987:152-156. 35. Chittum ME, Grutzmacher RD, Oiland DM, Kalina RE. Contamination of corneal tissue from infected donors . Arch Ophthalmol . 1985;103:802-805.Crossref 36. Lindquist TD, Cameron JD, Havener VR, Rubenstein JB, Lindstrom RL, Doughman DJ. Unsuspected infectious keratitis in host corneal buttons . Surv Ophthalmol . 1989;33:359-365.Crossref 37. Heck E, Petty C, Palestine A, Luckenbach M, et al. ELISA HIV testing and viral culture in the screening of corneal tissue for transplant from medical examiners' cases . Cornea . 1989;8:77-80.Crossref 38. Fujikawa LS, Palestine AG, Nussenblatt RB, et al. Isolation of human T-lymphotrophic virus type III from the tears of a patient with the acquired immunodeficiency syndrome . Lancet . 1988;2:529-530. 39. Salahuddin SZ, Palestine AG, Heck E, et al. Isolation of the human T-cell leukemia/lymphotropic virus type III from the cornea . Am J Ophthalmol . 1986;101:149-152. 40. Hale LM. Povidone-iodine in ophthalmic surgery . Ophthalmic Surg . 1970;1:9-13. 41. Wille H. Assessment of possible toxic effects of polyvinylpyrrolidone upon the human eye in conjunction with cataract surgery . Acta Ophthalmol . 1982;60:955-960.Crossref 42. Mac Rae SM, Brown BB, Edelhauser HF. The corneal toxicity of presurgical skin antiseptics . Am J Ophthalmol . 1984;97:221-232. 43. Berkelman RL, Holland BW, Anderson RL. Increased bactericidal activity of dilute preparations of povidone-iodine solutions . J Clin Microbiol . 1982;15:635-639. 44. Haley CE, Marling-Cason M, Smith JW, Luby JP, Mackowiak PA. Bactericidal activity of antiseptics against methicillin-resistant Staphylococcus aureus . J Clin Microbiol . 1985;21:991-992. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

An Evaluation of Saline Irrigation and Comparison of Povidone-Iodine and Antibiotic in the Surface Decontamination of Donor Eyes

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1991.01080060133041
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Abstract

Abstract • We evaluated the effect of saline irrigation on 38 pairs of donor eyes and determined the relative efficacy of antibiotic rinse/storage (neomycin-polymyxin B-gramicidin) and povidone-iodine immersion. Microbial growth was found in 49 (64.5%) of 76 eyes from which cultures were taken before irrigation, and only four (8.2%) became culture negative after irrigation. Of 27 eyes culture negative before irrigation, 15 (55.6%) became positive after irrigation. One eye of each pair was then assigned randomly to antibiotic rinse/storage and the other eye to 3-minute immersion in 1% povidone-iodine. Both antimicrobial treatments decreased the numbers of positive cultures, with povidone-iodine showing an advantage that did not reach significance. These results demonstrate that saline irrigation of donor eyes in situ does not reduce surface contamination and that povidone-iodine immersion should be considered as an alternative for donor eve decontamination. References 1. Pardos GJ, Gallagher MA. Microbial contamination of donor eyes, a retrospective study . Arch Ophthalmol . 1982;100:1611-1613.Crossref 2. Leveille AS, Dickinson M, Cavanaugh HD. Endophthalmitis following penetrating keratoplasty . Ophthalmology . 1983;90:38-39.Crossref 3. Paton R. Keratoplasty . New York, NY: McGraw-Hill International Book Co; 1958. 4. Rollins MJ, Stocker FW. Bacterial flora and preoperative treatment of donor corneas . Am J Ophthalmol . 1965;59:247-249. 5. Polack FM, Locathcher-Khorazo D, Gutierrez E. Bacteriologic study of 'donor' eyes, evaluation of antibacterial treatments prior to corneal grafting . Arch Ophthalmol . 1967;78:219-225.Crossref 6. Mascarella K, Cavanaugh HD. Penetrating keratoplasty using McCarey-Kaufman preserved corneal tissue . South Med J . 1979;72:1268-1271.Crossref 7. Mathers WD, Lemp MA. Corneal rim cultures . Cornea . 1987;6:231-233.Crossref 8. Larson EL. APIC guidelines for infection control practice: guidelines for use of topical antimicrobial agents . Am J Infect Control . 1988;16:253-266.Crossref 9. Connel JF, Rousselot LM. Povidone-iodine: extensive surgical evaluation of a new antiseptic agent . Am J Surg . 1964;108:849-855.Crossref 10. Wille H. Assessment of possible toxic effects of polyvinyl pyrrolidone-iodine upon the human eye in conjunction with cataract extraction: an endothelial specular microscope study . Acta Ophthalmol . 1986;60:955-960.Crossref 11. Klic F, Boge-Rasmussen I, Jenson OL. The effect of polyvinylpyrrolidone-iodine as an disinfectant in eye surgery . Acta Ophthalmol . 1986;64:67-71. 12. Mindrup FA, Skelnik DL, Albert DL, Lindstrom RL, Doughman DJ. A comparative study of the use of P-I and gentamicin in the decontamination of human donor globes . Invest Ophthalmol Vis Sci . 1985;26( (suppl) ):39. Abstract. 13. White JH. Fungal contamination of donor eyes . Br J Ophthalmol . 1969;53:30-33.Crossref 14. LeFrancois M, Baum JL. Flavobacterium endophthalmitis following keratoplasty . Arch Ophthalmol . 1976;94:1907-1909.Crossref 15. Shaw EL, Aquavella JV. Pneumococcal endophthalmitis following grafting of corneal tissue from a (cadaver) kidney donor . Ann Ophthalmol . 1977;9:435-440. 16. Larsen PA, Lindstrom RL, Doughman DJ. Torulopsis glabrata endophthalmitis after keratoplasty with an organ-cultured cornea . Arch Ophthalmol . 1978;96:1019-1022.Crossref 17. Beyt BE, Waltman SR. Cryptococcal endophthalmitis after corneal transplantation . N Engl J Med . 1978;298:825-826.Crossref 18. Escapini H, Olson RJ, Kaufman HE. Donor cornea contamination with McCarey-Kaufman medium preservation . Am J Ophthalmol . 1980;88:59-62. 19. Khodadoust AA, Franklin RM. Transfer of bacterial infection by donor cornea in penetrating keratoplasty . Am J Ophthalmol . 1979;87:130-132. 20. Guss RG, Koenig S, DeLaPena W, Marx M, Kaufman ME. Endophthalmitis after penetrating keratoplasty . Am J Ophthalmol . 1983;95:651-658. 21. Jones S, Cohen EJ, Arentsen JS, Laibson PR. Ocular streptococcal infections . Cornea . 1988;7:295-299.Crossref 22. Baer JC, Nirankari VS, Glaros DS. Streptococcal endophthalmitis from contaminated donor corneas after keratoplasty: clinical and laboratory investigations . Arch Ophthalmol . 1988;106:517-520.Crossref 23. Lindquist TD, Weber K, Spika J, Facklam R. Gentamicin-resistant streptococcal endophthalmitis after keratoplasty . Cornea . 1990;9:88-89. 24. Yau CW, Bosin M, Avni I, Kaufman HE. Antibacterial effect of donor corneas stored in gentamicin-enriched McCarey-Kaufman medium . Arch Ophthalmol . 1986;104:263-265.Crossref 25. Goldman KN, Centifonto Y, Kaufman HE, Sloppey TE. Prevention of surface bacterial contamination of donor corneas . Arch Ophthalmol . 1978;96:2277-2280.Crossref 26. Isenberg S, Apt L, Yoshimuri R. Chemical preparation of the eye in ophthalmic surgery, I: effect of conjunctival irrigation . Arch Ophthalmol . 1983;101:761-763.Crossref 27. Harvey SC. Antiseptics and disinfectants; fungicides; ectaparasiticides . In: Gilman AG, Goodman LS, Gilman AF, eds. The Pharmacological Basis of Therapeutics . 6th ed. New York, NY: Macmillan Publishing Co Inc; 1980:973. 28. Truman JR. The halogens . In: Hugo WR, ed. Inhibition and Destruction of the Microbial Cell . London, England: Academic Press Inc; 1971:183-196. 29. Gottardi W. Iodine and iodine compounds . In: Block SS, ed. Disinfection, Sterilization, and Preservation . 3rd ed. Philadelphia, Pa: Lea & Febiger; 1983:183-196. 30. Benevento WJ, Hurray P, Reed AR, Peposa JS. The sensitivity of Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex type II to disinfection with povidone-iodine . Ophthalmology . 1990;19:329-333. 31. Plorkin SA. The effect of povidone-iodine on several viruses . In: Polk HC, Ehrenkranz N, eds. Therapeutic Advances and New Clinical Implications: Medical and Surgical Antisepsis With Betadine Microbicides . Coral Gables, Fla: Purdue Frederick Co; 1972. 32. Harbison MA, Hammer SM. Inactivation of human immunodeficiency virus by Betadine products and chlorhexidine . J AIDS . 1989;2:16-20. 33. Marks LS, McDougal JS, Laskoski SL. Disinfection and inactivation of human immunodeficiency virus by Betadine . Infect Control . 1987;8:412-414. 34. Durno AG, Kaplan JC, Schooley RT. Inactivation of human immunodeficiency virus by povidone-iodine . In: Digenis GA, Agha BJ, Ansel J, Blecher L, eds. Proceedings of the Second International Symposium on Povidone . Lexington, Ky: Kentucky College of Pharmacy, University of Kentucky; 1987:152-156. 35. Chittum ME, Grutzmacher RD, Oiland DM, Kalina RE. Contamination of corneal tissue from infected donors . Arch Ophthalmol . 1985;103:802-805.Crossref 36. Lindquist TD, Cameron JD, Havener VR, Rubenstein JB, Lindstrom RL, Doughman DJ. Unsuspected infectious keratitis in host corneal buttons . Surv Ophthalmol . 1989;33:359-365.Crossref 37. Heck E, Petty C, Palestine A, Luckenbach M, et al. ELISA HIV testing and viral culture in the screening of corneal tissue for transplant from medical examiners' cases . Cornea . 1989;8:77-80.Crossref 38. Fujikawa LS, Palestine AG, Nussenblatt RB, et al. Isolation of human T-lymphotrophic virus type III from the tears of a patient with the acquired immunodeficiency syndrome . Lancet . 1988;2:529-530. 39. Salahuddin SZ, Palestine AG, Heck E, et al. Isolation of the human T-cell leukemia/lymphotropic virus type III from the cornea . Am J Ophthalmol . 1986;101:149-152. 40. Hale LM. Povidone-iodine in ophthalmic surgery . Ophthalmic Surg . 1970;1:9-13. 41. Wille H. Assessment of possible toxic effects of polyvinylpyrrolidone upon the human eye in conjunction with cataract surgery . Acta Ophthalmol . 1982;60:955-960.Crossref 42. Mac Rae SM, Brown BB, Edelhauser HF. The corneal toxicity of presurgical skin antiseptics . Am J Ophthalmol . 1984;97:221-232. 43. Berkelman RL, Holland BW, Anderson RL. Increased bactericidal activity of dilute preparations of povidone-iodine solutions . J Clin Microbiol . 1982;15:635-639. 44. Haley CE, Marling-Cason M, Smith JW, Luby JP, Mackowiak PA. Bactericidal activity of antiseptics against methicillin-resistant Staphylococcus aureus . J Clin Microbiol . 1985;21:991-992.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jun 1, 1991

References