| Objective: To compare the effects of different concentration(0.5%,0.1%,0.05%)of Povidone Iodine(PVI)before cataract surgery on the conjunctival sac irrigation at different time(30s,1min and 2min),and to observe the disinfection effect of PVI and the influence on the ocular surface.The optimum concentration and time of PVI were screened to provide a theoretical basis for clinical standardization of drug use.Methods: From June 2016 to June 2017 in He Bei General Hospital underwent cataract surgery in 270 cases 270 eyes,one eye into the group,according to the concentration(0.5%,0.1%,0.05%)of the drug were randomly divided into A group,B group,C group,each of them was 90 eyes.A group were randomly divided into A1 group,A2 group,A3 group respectively corresponding to different time: 30 s,1min and 2min.B group and C group were divided similar to A group,each group of 30 eyes.All the patients were randomly divided into PVI conjunctival sac flushing and collected samples before and after irrigation.The change of conjunctival sac bacterial flora and bacterial culture positive rate before and after flushing were compared,and tear Break Up Time(BUT),Cornea Fluorescein Staining(CFS),Schirmer Test Ⅰ(STⅠ),Lacrimal River Height(LRH),Conjunctival Impressive Cytology(IC)changes were compared preoperation 3d with postoperation 1d,3d,1w,1m,3m,and the effect of PVI on ocular surface was observed.Results: No endophthalmitis was found in all patients at the last follow-up.Firstly,the change of conjunctival sac bacterial flora: The species of conjunctival bacterial culture(n=12)before flushing include Gram positive bacteria(n=9)and Gram negative bacteria(n=3),after PVI flushing bacterial culture(n=4)contain Gram positive bacteria(n=2)and Gram negative bacteria(n=2).Secondly,Comparison of the positive rate of bacterial culture in conjunctival sac: there were 15 eyes show positive before PVI flushing,5 eyes show positive after washing,the amount of positive bacteria culture were less than before,the difference was statistically significant(P = 0.02,P<0.05).(1)Comparison of the same concentration for different action time: Group A: there was no significant difference in positive rate of bacterial culture among three groups before and after irrigation(P>0.05);Group B: there was no significant difference in positive rate of bacterial culture among three groups before and after flushing(P > 0.05);Group C: there was no statistically significant difference in the positive rate of bacteria among three groups before and after washing(P>0.05).(2)Comparison of different concentration at the same action time:(1)in 30 s group: there was no statistically significant difference in the positive rate of bacteria among three groups before and after washing(P>0.05).(2)In 1min group and 2min group,there was no statistically significant difference in the positive rate of bacterial culture before and after flushing(P>0.05).Thirdly,evalue the risk factors of positive bacterial culture: older age(more than 70 years)(P=0.06,P>0.05),gender(P=0.81,P>0.05)and eye(P=0.56,P>0.05)regardless with positive rate of bacterial culture.Fourthly,analysis of ocular surface results: Compared with the application of high concentration(0.5% and 0.1%)PVI in the different time(30s,1min,2min),the 0.05%PVI act 30 s group had smaller ocular surface damage and faster postoperative recovery than the other groups.Conclusion: 0.05%PVI conjunctival sac flushing 30 s can effectively reduce the bacteria of conjunctival sac,and can be used safely for the disinfection of conjunctival sac before cataract surgery.At the same time,it can reduce ocular surface damage and relieve postoperative discomfort,which is beneficial to the recovery of early ocular surface function. |
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