Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis:

doi:10.1177/24741264211013622

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Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis:

Journal Article•DOI•

Hypochlorous Acid 0.01% vs Povidone-Iodine 5% for Ocular Antisepsis:

Thomas W. Hejkal, Lauren Maloley¹, Layan Kaddoura•Institutions (1)

University of Nebraska Medical Center¹

21 May 2021-pp 247412642110136

TL;DR: Both HA and PI were effective in reducing ocular bacterial load and unlike PI, HA was not irritating to the eye.

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Abstract: Purpose:An alternative ocular antiseptic is needed for patients who do not tolerate povidone-iodine (PI). The purpose of this study is to compare the antimicrobial effect of hypochlorous acid (HA) ...

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Journal Article•

Survey of Intravitreal Injection Techniques Among Retinal Specialists in the United States

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Amy E. Green-Simms¹, N. S. Ekdawi¹, Sophie J. Bakri¹•Institutions (1)

Mayo Clinic¹

17 Apr 2010-Investigative Ophthalmology & Visual Science

TL;DR: In this paper, the authors describe the intravitreal injection technique practice patterns of retinal specialists in the United States from April 8, 2010 to April 21, 2010 from the American Academy of Ophthalmology who self-categorized as retinal/vitreous surgery.

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Abstract: Purpose To describe the intravitreal injection technique practice patterns of retinal specialists in the United States from April 8, 2010 to April 21, 2010. Design Questionnaire survey. Methods All members of the American Academy of Ophthalmology who self-categorized as “Retinal/Vitreous Surgery” were contacted by e-mail to complete an anonymous, 20-question, internet-based survey. Results A total of 765 retinal specialists (44%) responded to the survey. Most respondents wear gloves (58%) and use an eyelid speculum (92%) when performing an intravitreal injection. More than 99% use povidone-iodine preinjection. The majority measure the injection site from the limbus (56%) and inject straight into the vitreous cavity (96%). Most do not displace the conjunctiva (83%). Seventy-two percent routinely assess postinjection optic nerve perfusion, primarily by gross visual acuity measurement (32%). While nearly one third of participants use prophylactic topical antibiotics preinjection, more than two thirds use topical antibiotics postinjection. Forty-six percent perform bilateral simultaneous intravitreal injections. The majority of respondents use a 30-gauge needle for the injection of ranibizumab (78%) and bevacizumab (60%). However, respondents use both a 27- and 30-gauge needle for the injection of triamcinolone acetonide. Conclusions Retinal specialists in the United States participate in a range of techniques for the care before, during, and after intravitreal injections. Further study is needed to elucidate best practice patterns.

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4 citations

Time-Kill Comparison of Povidone Iodine to Hypochlorous Acid against Endophthalmitis Isolates of Staphylococci

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Matthew S. Klocek, Deepinder K. Dhaliwal, Alex Mammen, Regis P. Kowalski

01 Jan 2018

TL;DR: In this article, the antibacterial activity of Povidone Iodine (PI) and Hypochlorous Acid (HA) were compared against endophthalmitis isolates of Staphylococcus aureus and coagulase-negative Staphymus using time-kill studies.

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Abstract: Purpose: We compared the antibacterial activity of Povidone Iodine (PI) and Hypochlorous Acid (HA) against endophthalmitis isolates of Staphylococcus aureus and coagulase-negative Staphylococcus using time-kill studies. Methods: Time-kill studies of PI, HA (0.008%), and HA (0.01%, Avenova), were conducted in duplicate against MethicillinSusceptible Staphylococcus aureus (MSSA), Methicillin-Resistant Staphylococcus aureus (MRSA), and Coagulase Negative Staphylococcus (CNS) at time points 1, 2, 10, and 30 minutes. Each antiseptic was inoculated to a final bacterial concentration of 106 CFU/mL. The main outcome measure was based on a bactericidal decrease in colony counts units (CFU) (3 log10 or 99.9% decrease). Results: At 1 minute, HA (0.008% and 0.01%) were more bactericidal than PI for decreasing the CFU of MRSA, MSSA, and CNS (p=0.045, Fisher’s Exact Test). At 2 minutes, the bactericidal effect was equivalent for PI and HA (0.008% and 0.01%) against the three Staphylococcal groups. The bactericidal effects of HA 0.008% and HA 0.01% were equivalent at all time points against all three Staphylococcal groups. Conclusions: Povidone iodine is the current gold standard for endophthalmitis prophylaxis. This in vitro study supports a 2-minute contact time between Staphylococci and PI for a bactericidal effect. The contact time between HA (0.008% and 0.01%) and Staphylococci for a bactericidal effect appears to be reduced to 1 minute.

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2 citations

Journal Article•DOI•

Description of non-brachycephalic canine conjunctival microbiome before and after application of an antiseptic preparation.

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Lindsay D Seyer, Robert W. Wills, Erin M. Scott, Caroline M. Betbeze

08 May 2022-Veterinary Ophthalmology

TL;DR: Conjunctival bacterial flora identified differed between culture dependent and independent methods, but the bacterial community remained stable over time after application of the antiseptic preparation.

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Abstract: OBJECTIVE To evaluate canine conjunctival microbiome before and after an antiseptic preparation using aerobic culture and DNA sequencing. ANIMALS STUDIED Six healthy non-brachycephalic dogs. PROCEDURES Dogs randomly received povidone-iodine 1:50 dilution solution in one eye with the second eye serving as a control. Standardized volumes of solution, number of sterile cotton tipped applicators, and preparation times of 5 min were used. Aerobic culture and DNA sequencing samples were collected from inferior conjunctival fornices at baseline, immediately following, 24 h, and 4 weeks following antiseptic preparation. Aerobic culture data were evaluated using paired t-test and linear regression. Illumina platform was used to sequence bacterial DNA using primers to target the V4 region of bacterial 16S rRNA. Quantitative Insights Into Molecular Ecology (QIIME 2.0) was used to analyze data. RESULTS Baseline aerobic cultures consisted of Bacillus (35%), Staphylococcus (30%), Streptococcus (20%), Moraxella (5%), Micrococcus (5%), and Simonsiella spp. (5%). No significant difference was detected in mean number of species cultured at baseline and following treatment (p = .465). Treatment, sample time, or interaction was not significant (p > .393). The most abundant phyla at baseline via DNA sequencing were Proteobacteria (57.04%), Actinobacteria (19.89%), Firmicutes (3.25%), and Bacteroidetes (5.5%). Alpha and beta diversity matrices at baseline and over time revealed no significant change in species richness or bacterial composition. Relative abundance of bacterial taxa did not significantly differ in treated or control eyes over time. CONCLUSIONS Conjunctival bacterial flora identified differed between culture dependent and independent methods. The bacterial community remained stable over time after application of the antiseptic preparation.

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Journal Article•DOI•

Intravitreal Injection Technique and Monitoring: Updated Guidelines of an Expert Panel

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Robert L. Avery, Sophie J. Bakri¹, Mark S. Blumenkranz², Alexander J. Brucker³, Emmett T. Cunningham⁴, Donald J DʼAmico⁵, Pravin U. Dugel, Harry W. Flynn⁶, K. Bailey Freund⁷, Julia A Haller⁸, J. Michael Jumper, Jeffrey M Liebmann⁹, Colin A. McCannel¹⁰, William F. Mieler¹¹, Christopher N. Ta¹², George A. Williams² - Show less +12 more•Institutions (12)

Mayo Clinic¹, Stanford University², University of Pennsylvania³, California Pacific Medical Center⁴, University of California, San Francisco⁵, Cornell University⁶, University of Southern California⁷, Bascom Palmer Eye Institute⁸, Wills Eye Institute⁹, Manhattan Eye, Ear and Throat Hospital¹⁰, University of California, Los Angeles¹¹, University of Illinois at Chicago¹²

01 Dec 2014-Retina-the Journal of Retinal and Vitreous Diseases

TL;DR: New guidelines on IVT injection technique and monitoring are proposed based on a review of published literature and expert panel deliberations and emphasized the continued importance of applying povidone–iodine to and avoiding eyelid contact with the intended injection site and needle.

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Abstract: Purpose To review evidence and provide updated guidelines on intravitreal (IVT) injection technique and monitoring. Methods A review of the published literature on IVT injection from 2004 to 2014 formed the basis for round table deliberations by an expert panel of ophthalmologists. Results The dramatic increase in the number of IVT injections has been accompanied by a comparable increase in evidence surrounding IVT practice patterns and techniques. The expert panel identified a number of areas that have evolved since publication of the original IVT injection guidelines in 2004, the most notable of which were a lack of evidence to support the routine use of pre-, peri-, and postinjection antibiotics to reduce the risk of endophthalmitis, and the role of aerosolized droplets containing oral contaminants from the patient and/or providers as a potential source of infection. The panel emphasized the continued importance of applying povidone-iodine to and avoiding eyelid contact with the intended injection site and needle. Conclusion Updated guidelines on IVT injection technique and monitoring are proposed based on a review of published literature and expert panel deliberations.

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211 citations

Journal Article•DOI•

Chemical Preparation of the Eye in Ophthalmic Surgery: III. Effect of Povidone-Iodine on the Conjunctiva

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Leonard Apt, Sherwin J. Isenberg, Robert Yoshimori, Juan H. Paez

01 May 1984-Archives of Ophthalmology

TL;DR: Half-strength povidone-iodine (Betadine) solution was used topically as part of the preoperative chemical preparation of the eye for surgery and the numbers of colonies and species of bacteria decreased.

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Abstract: • A half-strength povidone-iodine (Betadine) solution was used topically as part of the preoperative chemical preparation of the eye. Aerobic and anaerobic bacterial cultures of the conjunctiva were taken before and after the chemical preparation in 30 consecutive patients; the second eye served as a control. In the control eyes, no significant change in the number of colonies or species of bacteria was found. In the povidone-iodine-treated eyes, the numbers of colonies decreased 91% and the number of species decreased 50% (statistically significant). We therefore recommend that a halfstrength povidone-iodine solution be used as part of the chemical preparation of the eye for surgery.

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204 citations

"Hypochlorous Acid 0.01% vs Povidone..." refers result in this paper

...Patients being prepared for surgery will generally also have the eyelids, lashes, and periocular skin swabbed with PI....
[...]
...Only the eyes that had more than 1 CFU at baseline were included in the analysis: 21 for HA and 17 for PI....
[...]
...Although patients cannot have a true allergy to elemental iodine, some patients may have a hypersensitivity reaction to other components of PI....
[...]
...Others have recognized the need for an alternative, and studies have been conducted that show that lower concentrations of PI or chlorhexidine could be possible alternatives to 5% PI.6-11 Hypochlorous acid (HA) 0.01% (Avenova, NovaBay Pharmaceuticals) has potent in vitro bactericidal activity and has minimal in vitro cytotoxic effects.12 Rani et al12 demonstrated that HA 0.01% had the highest bactericidal effect (10 000-fold reduction in Staphylococcus aureus after 1-minute exposure) compared with several other skin disinfectants and that it was nontoxic to fibroblasts in cell culture at this concentration....
[...]
...Therefore, an alternative antiseptic is needed that is just as effective as PI for disinfection of the ocular surface but that is painless and has less corneal toxicity than PI; an alternative is especially needed for patients who are allergic to or who do not tolerate PI....
[...]

Journal Article•DOI•

Comparison of 5% povidone-iodine solution against 1% povidone-iodine solution in preoperative cataract surgery antisepsis: a prospective randomised double blind study

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A W Ferguson¹, J A Scott, J McGavigan, R A Elton, J McLean, U Schmidt, R Kelkar, B Dhillon - Show less +4 more•Institutions (1)

University of Stirling¹

01 Feb 2003-British Journal of Ophthalmology

TL;DR: Despite in vitro evidence of higher bactericidal efficacy of PI at more dilute concentrations, 5% PI is more effective than 1% PI in decreasing the human conjunctival bacterial flora in vivo, particularly in the presence of heavier initial bacterial load.

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Abstract: Background/aim: Povidone-iodine (PI, Betadine) is routinely used as a preoperative topical antiseptic in cataract surgery as it has been shown to reduce the incidence of postoperative endophthalmitis. However, the concentration used clinically is variable. In vitro studies have shown that PI is paradoxically more effective at lower concentration. This study was undertaken to determine if this effect was reproducible in vivo. Methods: A prospective randomised double blind study was carried out in the ophthalmic theatre in a district general hospital. 105 patients attending for routine cataract surgery were randomly allocated to have their conjunctival fornices irrigated preoperatively with either PI 1% (group A) or PI 5% (group B). Conjunctival swabs were taken, in identical fashion, both before and 1 minute after irrigation. The number and species of bacterial colonies cultured from each swab was counted. The difference in the median number of bacterial colonies from pre-irrigation to post-irrigation cultures was then compared between the groups. Results: Bacterial cultures were gained from 100 patients (33 male, 67 female, mean age 74 years, range 30–95 years). Group B (5% PI) showed a decrease in median colony forming units (CFU) pre-irrigation from 100 to 40 CFU post-irrigation (a drop of 60%). This was greater than in group A (1% PI) where the reduction was 120 CFU pre-irrigation to 100 CFU post-irrigation (a drop of 16.7%) (Mann-Whitney test, p 1000), the difference in median between the two groups became larger as the number of pre-irrigation bacteria increased. In group B pre-irrigation CFU reduced from 3340 to 110 post-irrigation (a drop of 96.7%) compared with group A: 5000 CFU pre-irrigation to 3000 post-irrigation (a drop of 40%) (Mann-Whitney test, p=0.0014). Conclusion: Despite in vitro evidence of higher bactericidal efficacy of PI at more dilute concentrations, 5% PI is more effective than 1% PI in decreasing the human conjunctival bacterial flora in vivo, particularly in the presence of heavier initial bacterial load.

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135 citations

"Hypochlorous Acid 0.01% vs Povidone..." refers background or result in this paper

...Patients being prepared for surgery will generally also have the eyelids, lashes, and periocular skin swabbed with PI....
[...]
...Only the eyes that had more than 1 CFU at baseline were included in the analysis: 21 for HA and 17 for PI....
[...]
...Although patients cannot have a true allergy to elemental iodine, some patients may have a hypersensitivity reaction to other components of PI....
[...]
...Others have recognized the need for an alternative, and studies have been conducted that show that lower concentrations of PI or chlorhexidine could be possible alternatives to 5% PI.6-11 Hypochlorous acid (HA) 0.01% (Avenova, NovaBay Pharmaceuticals) has potent in vitro bactericidal activity and has minimal in vitro cytotoxic effects.12 Rani et al12 demonstrated that HA 0.01% had the highest bactericidal effect (10 000-fold reduction in Staphylococcus aureus after 1-minute exposure) compared with several other skin disinfectants and that it was nontoxic to fibroblasts in cell culture at this concentration....
[...]
...Therefore, an alternative antiseptic is needed that is just as effective as PI for disinfection of the ocular surface but that is painless and has less corneal toxicity than PI; an alternative is especially needed for patients who are allergic to or who do not tolerate PI....
[...]

Journal Article•DOI•

Survey of intravitreal injection techniques among retinal specialists in the United States.

[...]

Amy E. Green-Simms¹, N. S. Ekdawi¹, Sophie J. Bakri¹•Institutions (1)

Mayo Clinic¹

01 Feb 2011-American Journal of Ophthalmology

TL;DR: The intravitreal injection technique practice patterns of retinal specialists in the United States from April 8, 2010 to April 21, 2010 are described to elucidate best practice patterns.

...read moreread less

114 citations

Journal Article•DOI•

Povidone-iodine contact time and lid speculum use during intravitreal injection.

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Duncan A. Friedman, John O. Mason, Tracy L. Emond, Gerald McGwin

01 May 2013-Retina-the Journal of Retinal and Vitreous Diseases

TL;DR: The use of 5% PI causes a significant reduction in bacterial colonies, and 30 seconds of exposure appears to be an adequate time to decrease conjunctival bacterial counts.

...read moreread less

Abstract: Purpose:To determine the time necessary for 5% povidone–iodine (PI) to cause a significant reduction in colony-forming units and whether a lid speculum increases the conjunctival flora.Methods:This was a prospective randomized study of 131 eyes undergoing intravitreal injection. Conjunctival samples

...read moreread less

85 citations

"Hypochlorous Acid 0.01% vs Povidone..." refers result in this paper

...Patients being prepared for surgery will generally also have the eyelids, lashes, and periocular skin swabbed with PI....
[...]
...Only the eyes that had more than 1 CFU at baseline were included in the analysis: 21 for HA and 17 for PI....
[...]
...Although patients cannot have a true allergy to elemental iodine, some patients may have a hypersensitivity reaction to other components of PI....
[...]
...Others have recognized the need for an alternative, and studies have been conducted that show that lower concentrations of PI or chlorhexidine could be possible alternatives to 5% PI.6-11 Hypochlorous acid (HA) 0.01% (Avenova, NovaBay Pharmaceuticals) has potent in vitro bactericidal activity and has minimal in vitro cytotoxic effects.12 Rani et al12 demonstrated that HA 0.01% had the highest bactericidal effect (10 000-fold reduction in Staphylococcus aureus after 1-minute exposure) compared with several other skin disinfectants and that it was nontoxic to fibroblasts in cell culture at this concentration....
[...]
...Therefore, an alternative antiseptic is needed that is just as effective as PI for disinfection of the ocular surface but that is painless and has less corneal toxicity than PI; an alternative is especially needed for patients who are allergic to or who do not tolerate PI....
[...]