Comparison of Povidone-Iodine and Gentamicin Soak as Scleral Buckle Infection Prophylaxis

Abstract

Objective

To determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.

Design

Experimental study.

Participants

Scleral buckle elements were soaked in either gram-positive or polymicrobial broth, while control buckle elements were soaked in PBS only.

Methods

Solid silicone and sponge scleral buckle elements were inoculated with common pathogens of the ocular surface, and then soaked in either 1% or 5% povidone-iodine, 1 mg/mL gentamicin solution, or sterile saline for 1, 5, 10, or 15 minutes. Bacteria were then isolated from the buckle elements and cultured for 24 hours.

Results

In all gram-positive bacterial conditions, gentamicin solution decreased the bacterial load from 451,666.67 colony-forming units (CFU)/mL to 171,611.11 CFU/mL (p=0.0004). The fractional bacterial survival after soaking in gentamicin was higher for the silicone sponge than band (0.357 vs 0.079, p=0.038). Both 1% and 5% povidone-iodine were able to completely eradicate all gram-positive bacteria of both buckle elements. Only 5% povidone-iodine was able to completely sterilize all microbes on the buckle after soaking in a polymicrobial solution consisting of gram-positive, gram-negative bacteria, and fungi.

Conclusion

Povidone-iodine solution was significantly more effective at bacterial eradication compared to gentamicin solution. For all scleral buckle procedures, we recommend soaking the buckle element in 2–3% povidone-iodine solution before placement and rinsing the ocular surface with the same solution after placement.

Keywords:

• gentamicin
• povidone-iodine
• sterilization

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest.

Additional information

Funding

This work was supported by the National Eye Institute [F30-EY025923] (to Patrick SY Lee); Research to Prevent Blindness [P30-EY04068] (Non-restricted grant to the Department of Ophthalmology, Visual and Anatomical Sciences).