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  • Year XXIII, N. 8, May 2020

    Innovation in Ophthalmology

    Preoperative preparation of the eye with TiAB wipes

    significantly reduces bacterial load: a case series

    Franco Passani, Rosario Denaro, Flavio Dalle Lucche, Andrea Passani, Eva Maria Parisio,

    Giulio Camarlinghi, Chiara Vettori

    O

  • Year XXIII, N. 8, May 2020

    Preoperative preparation of the eye with TiAB wipes significantly reduces bacterial load: a case series Franco Passani, Rosario Denaro, Flavio Dalle Lucche, Andrea Passani, Eva Maria Parisio, Giulio Camarlinghi, Chiara Vettori

    ISBN 978-88-6756-555-9 ISSN 2035-0252

    Editorial Board https://www.springerhealthcare.it/redazione/

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    © 2020 Springer Healthcare Italia S.r.l. In Focus. Registered in Milan - Registration n. 474 - 8/7/1997 Publishing Director: Giuliana Gerardo Online version Publication not for resale aimed at medical practitioners. All rights reserved throughout the world and in all languages. No part of this publication may be repro- duced, transmitted or stored in any form or by any means either mechanical or electronic, including photocopying, recording, or through an information storage and retrieval system, without the written per- mission of Springer Healthcare Italia S.r.l.. Springer Healthcare Italia S.r.l. is willing to acknowledge the copyright holder’s rights for any image used for which it has been unable to obtain permission to publish. It should be noted that, although great care has been taken in compiling and checking the content of this publication, Springer Healthcare Italia S.r.l. shall not be held responsible for any use that may be made of this publication or for any errors, omissions or inaccuracies therein. This publication is not a peer-reviewed publication. All opinions expressed in this publication reflect those of the authors and not necessarily those of Springer Healthcare Italia S.r.l. or NTC S.r.l.. The possible use of the trade names has the mere purpose of identifying the products and does not imply any suggestion of use. Each product must be used in accordance with the instructions for use (IFU) and/or summary of product characteristics (SPC) supplied by the relative manufacturing company. Publication made possible by an unconditioned educational grant from NTC S.r.l.

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  • Contents

    Abstract 2

    Introduction 2

    Materials and methods 5

    Results 6

    Discussion 8

    Conclusions 10

    References 10

    Preoperative preparation of the eye with TiAB wipes significantly reduces bacterial load: a case series Franco Passani1, Rosario Denaro1, Flavio Dalle Lucche1, Andrea Passani2, Eva Maria Parisio3, Giulio Camarlinghi3, Chiara Vettori3 1 High-Complexity Ophthalmology Unit, Massa-Carrara, Italy 2 Private Ophthalmologist, Pisa, Italy 3 Unit of Chemical-Clinical and Microbiological Analysis, San Luca Hospital, Usl Toscana Nord Ovest,

    Lucca, Italy

  • 2

    Preoperative preparation of the eye with TiAB wipes significantly reduces bacterial load: a case series

    Abstract

    Objective: To evaluate the efficacy of a commercially available non-antibiotic TiAB-

    based cleansing wipe for the eyelids in re-

    ducing bacterial load on the ocular surface

    before cataract surgery.

    Methods: A case series study was con- ducted at the Ophthalmology Unit of Massa

    Carrara to gather the first clinical experien-

    ces with this product (TiABLO®). The pur-

    pose of this study was to evaluate the effect

    of TiAB eyelid disinfection on periocular and

    eyelid microorganisms in 20 patients waiting

    for cataract surgery who were found positive

    for eyelid microorganisms, out of 70 consec-

    utive patients analysed. The patients received

    a preoperative treatment with a wipe soaked

    in a solution containing xanthan gum and

    titanium dioxide coated silver (TiABLO®,

    NTC). The periocular bacterial count was

    determined up to 2 hours after treatment.

    Results: In 16 out of 20 patients (80.0%) there was total eradication of the resident

    bacterial population. Measurements at T30’,

    T60’, and T120’ in the responders showed

    a percentage reduction of 50%, 60%, and

    100%, respectively, of the microbial load on

    the eyelids.

    Conclusions: The results suggest that the use of TiAB-based eyelid wipes as a com-

    plementary prophylactic method is able to

    reduce the periocular bioburden before any

    ocular surgery.

    Introduction

    Postoperative endophthalmitis is a serious

    complication of intraocular surgery. Sev-

    eral different bacterial species are able to

    cause endophthalmitis after surgical proce-

    dures[1,2], and sometimes with serious con-

    sequences and poor final visual outcomes[3].

    Endophthalmitis can occur following any

    ocular surgery; however, because of the

    sheer number of operations, 90% of cases

    are associated with cataract surgery[4]. The

    principle of reducing bacterial colony counts

    in the surgical field is widely practised in

    surgery. As for cataract surgery, a number of

    prophylactic protocols have been designed,

    their rationale being mainly based on the

    experimental reduction in conjunctival

  • Preoperative preparation of the eye with TiAB wipes significantly reduces bacterial load: a case series

    3

    commensals by topical application of antibi-

    otics, disinfectants or both[5].

    Etiologic agents of acute postoperative endophthalmitis The etiologic agents of acute postoperative

    endophthalmitis are generally microorgan-

    isms of the eyelid margin, conjunctiva, and

    tear film. The normal microbiota from the

    eyelid and conjunctiva has already been

    described[6]. Depending on the study, the

    frequency of isolation of bacteria ranges

    from 16% to 100%, with microbial growth

    shown in approximately 50% of swabs from

    the conjunctiva and tears, and in more than

    50% of swabs from the eyelids[6]. The most

    common bacteria isolated from the eyelids,

    conjunctiva, and tears are Gram-positive

    bacteria, mostly coagulase-negative Staphy-

    lococcus spp. Bacteria present on the eyelid

    are responsible for acute postoperative en-

    dophthalmitis[7].

    To prevent the onset of postoperative en-

    dophthalmitis, several prophylactic strat-

    egies have been used. These approaches,

    which often feature the use of topical anti-

    biotics, are focused on reducing the bacterial

    load on the ocular surface on the assumption

    that this could reduce the risk of endoph-

    thalmitis[8]. The most commonly used treat-

    ments are perioperative topical antibiotics,

    preoperative topical antibiotics, intracameral

    antibiotics, antibiotics at the end of the sur-

    gery, and postoperative topical antibiotics[9].

    Bacterial resistance to antibiotics It is important to underline that among

    the factors responsible for the onset of en-

    dophthalmitis is the increased resistance of

    Staphylococcus and other pathogenic bacteria

    to an increasing number of antibiotics, in-

    cluding the latest generation (fluoroquino-

    lones). The most disturbing and widely ex-

    panding phenomenon throughout the world

    is the accumulation of multiple forms of re-

    sistance in some pathogenic bacteria. These

    multiresistant bacteria manage to prolifer-

    ate normally even in the presence of mul-

    tiple classes of antibiotics. Methicillin-resis-

    tant Staphylococcus aureus (MRSA) strains

    are the leading cause of hospital infections

    in the United States, and are increasing-

    ly causing infectious conjunctivitis, kerati-

    tis, endophthalmitis, and orbital cellulitis.

    Methicillin-resistant Staphylococcus species

    are not only resistant to methicillin, but

    also to all β-lactam antibiotics. Additionally,

    methicillin resistance might also be related

    to resistance to other classes of antibiotics,

    which may limit treatment options. Methi-

    cillin-resistant Staphylococcus is a major con-

    cern for global public health. Recently, stud-

    ies have focused on endophthalmitis caused

    by methicillin-resistant Staphylococcus[10].

    Some notable features of methicillin-resis-

    tant Staphylococcus-associated endophthal-

    mitis are as follows: a rise in the reported

    incidence rate[11], an association with poor

    visual outcome, and an association with re-

    sistance to fluoroquinolones[12].

    The development of bacterial resistance to

    specific antibiotics is a factor that ophthal-

    mologists must never overlook. The wide-

    spread and sometimes inappropriate use

    and incorrect dosages of broad-spectrum

    antibiotics, often aggravated by incomplete

    compliance and/or inadequate duration of

    treatment, generate the development of

  • 4

    resistance. The antibiotic resistance dat