1. Povidone–iodine is proven effective. Most ophthalmologists
agree that the most effective preventive measure against endoph-
thalmitis 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 povi-
done-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 aller-
gic 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.
2. Know your compounders. All products we use in eyes are
from manufacturers or accredited 503B compounding pharmacies. We
never dilute or mix our own cocktails. We get sterility reports from
the compounding pharmacies we use, so we know their products
have gone through all necessary processes and meet sterility stan-
dards.
3. Antibiotic drops before and after. Antibiotic drops are
proven effective, as long as patients understand instructions, can
afford their medications and are compliant. We use Gentamycin and
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