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Preoperatively soaking strabismus sutures in antiseptic reduces bacterial contamination
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Endophthalmitis after strabismus surgery is rare, but sutures soaked in antiseptic solution may help lower the risk, a study found.
“We propose that the cause of contamination is suture contact with eyelid margins and eyelashes and that the route of the infection is via scleral suture tracts,” the study authors said. “We therefore recommend that strabismus surgeons consider soaking sutures in povidone iodine prior to routine use.”
The prospective randomized study included 402 6-0 polyglactin muscle sutures used for strabismus surgery in 2008 and 2009. The sutures were randomly assigned to three groups. The control group comprised 61 untreated sutures. The second group included 200 antibiotic/steroid-coated sutures. The third group included 141 antibiotic/steroid-coated sutures soaked in povidone iodine.
Surgery was performed with normal sterilization and draping protocols. Sutures were cut into segments and placed on blood agar plates. Samples were incubated for 48 hours and examined for bacterial contamination.
Study results showed bacterial growth in 28% of sutures in the first group, 22% of sutures in the second group and 9% of sutures in the third group. Antibiotic/antiseptic coating resulted in a statistically significant reduction of bacterial growth (P = .006).
Results showed no complications from antibiotic-soaked or antiseptic-soaked sutures.
Staphylococcus epidermidis endophthalmitis was identified and treated in one patient 1 week after surgery, the authors said.
Perspective
Back to TopScott E. Olitsky, MD
Endophthalmitis following strabismus surgery is a rare but devastating event. The study by Eustis and Rhodes confirms the fact that sutures used during strabismus surgery are frequently contaminated. The sutures that were soaked in antiseptic and coated with antibiotic had a lower growth rate than those that were not. However, it is not known if the difference in growth following the treatment of the suture would translate to a lower risk of infection after surgery. Like many studies of endophthalmitis following surgery, a decrease in bacterial count can be achieved but it is not known if this result can be extrapolated to a decreased incidence of postoperative infection. Unless this is clarified, it may not be accurate to say that sutures used during strabismus surgery should be pre-treated this way.
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J Pediatr Ophthalmol Strabismus. 2012;49(4):206-209.
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