Eyeworld

EW NEWS & OPINION 20 The clearest answer I had found to date on the subject came from the bacteria—they went away with ei- ther amount of time povidone-io- dine was present prior to lidocaine gel (zero CFUs) and stayed put any time povidone-iodine was placed after lidocaine gel (mean of 139.6 and 157.2 CFUs, p=0.485 and p=0.176 for 30 seconds and 5 sec- onds, respectively, in comparison to control plates with no lidocaine gel or povidone-iodine). In other words, 1) use of povidone-iodine before li- docaine gel did effectively reduce bacterial counts, 2) it could be demonstrated in a laboratory proto- col, and 3) it was effective regardless of whether the antiseptic was re- tained on the plate for a full 30 sec- onds or for only 5 seconds prior to the gel. Also, the ability of lidocaine gel to block the effect of povidone- iodine was confirmed. References 1. Kozak I, Cheng L, Freeman WR. Lidocaine gel anesthesia for intravitreal drug administra- tion. Retina. 2005;25:994-8. 2. Miller JJ, Scott IU, Flynn HW Jr et al. Acute- onset endophthalmitis after cataract surgery (2000-2004): incidence, clinical settings, and visual acuity outcomes after treatment. Am J Ophthalmol. 2005;139:983-7. 3. Boden JH, Myers ML, Lee T et al. Effect of lidocaine gel on povidone-iodine antisepsis and microbial survival. J Cataract Refract Surg. 2008;34:1773-5. 4. Page MA, Fraunfelder FW. Safety, efficacy, and patient acceptability of lidocaine hy- drochloride ophthalmic gel as a topical ocular anesthetic for use in ophthalmic procedures. Clin Ophthalmol. 2009;3:601-9. 5. Lalwani GA, Flynn HW Jr, Scott IU et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005). Clinical features, causative organisms, and visual acuity out- comes. Ophthalmology. 2008;115:473-6. 6. Doshi RR, Leng T, Fung AE. Povidone-iodine before lidocaine gel achieves surface antisepsis. Ophthalmic Surg Lasers Imaging. 2011;42(4):346-9. Editors' note: Dr. Doshi has no finan- cial interests related to this article. Contact information Doshi: 415-600-3901, rrdoshi@gmail.com December 2011 Povidone-iodine before lidocaine gel anesthesia achieves surface antisepsis Rishi R. Doshi, M.D., Theodore Leng, M.D., Anne E. Fung, M.D. Doshi RR, Leng T, Fung AE. Povidone-iodine before lidocaine gel achieves surface antisepsis. Ophthalmic Surg Lasers Imaging. 2011;42(4):346-349. Abstract Background and objective: Viscous lidocaine interferes with ocular sur- face antisepsis. Our study was designed to evaluate the impact on surface antisepsis of different application sequences with lidocaine gel and povi- done-iodine solution. Study design/materials and methods: Blood agar plates inoculated with Staphylococcus epidermidis were treated with varying sequences of 2% lido- caine gel and 5% povidone-iodine solution. The plates were then incu- bated at 37 degrees Celsius for 24 hours, and bacterial growth was determined. Results: Plates on which povidone-iodine was applied alone or prior to li- docaine gel demonstrated no bacterial growth, regardless of whether the antiseptic was retained on the plate for 5 seconds or for 30 seconds. There was no statistically significant difference between bacterial growth on plates not treated with povidone-iodine and on plates treated with lido- caine gel alone or prior to povidone-iodine (p=0.553 and p=0.485, respec- tively). Conclusions: Povidone-iodine is effective at reducing bacterial counts when applied alone or prior to lidocaine gel. Lidocaine gel was confirmed to be a barrier to antisepsis when administered prior to povidone-iodine. Povidone-iodine continued from page 18 E yeWorld used the APACRS meeting in Seoul to launch its newest venture—a Ko- rean language edition of EyeWorld Asia-Pacific. "Korea is a dynamic and technologically advanced country, which makes EyeWorld a perfect fit there," said Donald R. Long, global publisher of Eye- World. Graham Barrett, M.D., said APACRS was looking for another way to communicate with Korean members on a regular basis. "We thought, 'Wouldn't it be fantastic to do that through the media?'" he said. There will be an exchange of information from sister EyeWorld publications, especially the Asia-Pacific and American editions, Dr. Barrett said. "It will be a lovely transfer in both directions," he said. "It's a great conduit for information to these different regions." Cur- rently there are three regional Asia-Pacific editions—the main Asia- Pacific magazine, an English-language India edition, and a China edition, which is translated into Chinese. More than 22,000 copies are sent to ophthalmologists throughout the Asia-Pacific region. "It's a natural progression to a model and structure that has already proved to be viable," Dr. Barrett said. Initially, the quarterly magazine will be sent to about 2,000 ophthalmologists in Korea and will gradu- ally increase to about 4,000 in 6 months. The Korean Society of Cataract and Refractive Surgery will maintain a presence in the mag- azine, especially with region-specific content and an editorial from the regional editor-in-chief. "It's a wonderful medium for the local so- ciety to communicate with its members," Dr. Barrett said. Chul Young Choi, M.D, is the managing editor, and Hungwon Tchah, M.D., is the regional editor-in-chief. "It is a great honor to have the opportunity to publish the Korean edition of EyeWorld Asia-Pacific," Dr. Choi said. New EyeWorld AP edition launched in Korea Despite the limitations of a lab- oratory protocol in describing the complexities of any surgical proce- dure, it follows that either povidone- iodine should be used prior to lidocaine gel for adequate antisepsis, or if anesthesia precedes antisepsis, a non-viscous anesthetic should be used. The larger implication is that we all must question whether the substances we routinely use may in- teract or interfere with one another and alter our ability to keep our pa- tients safe. It is often not clear which of our movements places our patients at greatest risk, and so each one must be examined. Of course, the final step toward achieving my goal of generating clinically useful information was to spread the word. After presenting the data to my fellow residents and our attendings at California Pacific Medical Center, we presented our findings at the Retina Society meet- ing in 2010. The meeting was a great way to gauge the interest of others in our work—based on the interest we received, we decided to submit the paper to Ophthalmic Surgery, Lasers, & Imaging 6 and were fortu- nate to have the editors agree that the findings hold clinical relevance for their broad readership of multi- ple specialties. Throughout the process, I en- joyed the fulfillment of knowing that what started out as a simple question in my mind was of interest and utility to others, and that even an ophthalmologist in training could participate in furthering a sci- ence despite himself being in the in- fancy of its discovery. I have now learned that I do not have more questions than answers because I am a resident but because this is the na- ture of medicine. Every practitioner is a scientist, and uncertainty is the vast bedrock on which science at- tempts to carve a meaningful pic- ture. Those who live in uncertainty, through their baseline need to ques- tion every protocol, are in a great position—they can make a contribu- tion to our understanding of the variables that, if not controlled, will control our outcomes. EW

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