RISK FACTORS FOR POST-CATARACT SURGERY ENDOPHTHALMITIS: IMPACT OF POVIDONE-IODINE VERSUS CHLORHEXIDINE ANTISEPSIS
DOI:
https://doi.org/10.56238/levv17n58-040Keywords:
Cataract Extraction, Endophthalmitis, Povidone-Iodine, ChlorhexidineAbstract
Introduction: Post-cataract surgery endophthalmitis remains a rare but potentially devastating complication, and perioperative antisepsis is one of the most important non-antibiotic preventive measures in modern cataract surgery. Povidone-iodine remains the conventional standard, whereas chlorhexidine has emerged as a possible alternative because of favorable tolerability and growing interest in individualized antiseptic protocols.
Objective: The main objective of this systematic review was to evaluate risk factors for post-cataract surgery endophthalmitis, with particular emphasis on the comparative role of povidone-iodine versus chlorhexidine antisepsis. Secondary objectives were to assess the influence of antiseptic concentration and protocol design, examine the interaction between antisepsis and adjunctive prophylactic measures, identify patient-related and surgery-related modifiers of infectious risk, compare efficacy and tolerability data across available studies, and evaluate the certainty of the current evidence base.
Methods: A systematic search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP. Eligible studies included randomized trials, cohort studies, registry analyses, outbreak reports, and systematic reviews focused on cataract surgery endophthalmitis, ocular antisepsis, or closely related prophylactic strategies. Human studies were prioritized, duplicate screening and extraction were performed independently, and risk of bias was assessed with RoB 2, ROBINS-I, and QUADAS-2 when applicable, with overall certainty judged using GRADE.
Results and Discussion: Twenty studies were included in the final qualitative synthesis. The available evidence showed that postoperative endophthalmitis risk is influenced by a multifactorial interaction among diabetes, posterior capsule rupture, surgical complexity, contamination control, institutional workflow, and prophylactic adherence. Direct cataract-specific comparisons between povidone-iodine and chlorhexidine were limited, and the strongest comparative signal favored chlorhexidine for ocular surface comfort and early tear-film recovery rather than for proven superiority in preventing clinical endophthalmitis. Povidone-iodine remained the most consistently supported antiseptic within guideline-based cataract protocols, while chlorhexidine appeared to be a reasonable alternative in selected patients.
Conclusion: Current evidence supports povidone-iodine as the reference standard for perioperative cataract antisepsis, with chlorhexidine representing a plausible and often better-tolerated alternative when individualized use is appropriate. Prevention of post-cataract surgery endophthalmitis depends not on antiseptic selection alone, but on integration of antisepsis with meticulous surgical technique, complication avoidance, adjunctive prophylaxis, and rigorous institutional infection-control pathways
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References
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