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ASCRS opposes restrictions on common preoperative measures
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The American Society of Cataract and Refractive Surgery registered opposition to restrictions on the use of diluted povidone-iodine solution for topical infection prophylaxis and the preoperative use of multi-dose eye drops on multiple patients.
The official position statement was drafted by the ASCRS Cataract Clinical Committee.
“Some members reported that surveyors have arbitrarily proscribed these well-established and common practices, without any evidence that they pose greater risk,” David F. Chang, MD, former ASCRS president and Cataract Clinical Committee member, said in a press release.
The position statement said that current literature “strongly supports” the use of preoperative povidone-iodine solution for preventing sepsis and endophthalmitis. The instillation of 5% povidone-iodine solution in the conjunctival sac to prevent endophthalmitis has been shown to be effective and has been widely used for decades, the statement said.
According to a recent ASCRS survey, one in three ASCs prepares the 5% solution by diluting commercially available 10% povidone-iodine with saline solution, the statement said.
“This practice has been shown to be safe and effective despite the labeling, ‘Do not use in the eye,’ present on the 10% Betadine solution. More recently, individually packaged 5% povidone-iodine preps have become commercially available, but at a significant cost premium,” the statement said.
The statement also defended the use of multi-dose eye drops on multiple patients.
“The safety and cost-effectiveness of multi-dose bottles are well recognized in the clinic and in the surgery setting. Safety guidelines have been established for the safe use of these products, including expiration 28 days after initial use, proper dispensing technique, and discarding of any bottle with suspected tip contamination,” the statement said.
The committee “strongly supports the current established practice of utilizing multi-dose eye drops on multiple patients, when proper protocols are followed,” the statement said. “Furthermore, diluting 10% povidone-iodine for surgical prophylaxis remains a common and appropriate option in preparing the surgical prophylaxis.”
“The Cataract Clinical Committee is not recommending or suggesting that there is only one best practice,” Chang said. “Rather, we want to defend those facilities that choose to use multi-use bottles or dilute 10% Betadine, based on the best medical judgment of their clinical staff.”
Perspective
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John A. Hovanesian, MD, FACS
It is not surprising that regulators inspecting ophthalmic ASCs have again tried to restrict the use of multi-dose preoperative topical medications as well as the dilution of 10% Betadine. This seems to occur commonly, as well-intentioned site reviewers who are non-ophthalmologists are trying to follow the letter of the law and simply do not know the excellent track record of these appropriate practices. This is one very good reason all eye surgeons should be members of ASCRS, which has again come to the defense of both patients and doctors, speaking common sense with the credibility of nearly 10,000 working eye surgeons.Click Here to Manage Email Alerts