Effect of lidocaine gel on povidone-iodine antisepsis and microbial survival.

PURPOSE: To determine whether the use of lidocaine gel prior to povidone-iodine antisepsis is associated with increased microbial survival. SETTING: Ophthalmology Department, Madigan Army Medical Center, Fort Lewis, Washington, USA. METHODS: A standardized suspension of Staphylococcus epidermidis was used to inoculate 5 blood agar plates that served as a control. A second group of 5 blood agar plates was inoculated, and then lidocaine gel was applied to the plates. A third group of 5 blood agar plates was inoculated, lidocaine gel was applied, and then povidone-iodine 5% was applied and allowed to cover the plates. A fourth group of 5 blood agar plates was inoculated, and then povidone-iodine 5% was allowed to cover the plates. Cultures of Staphylococcus aureus, Pseudomonas aeruginosa, and Haemophilus influenza were tested in a similar fashion. Microbial growth was evaluated after 24 hours. RESULTS: The number of colony forming units (CFUs) was similar in the control group and the S epidermidis, S aureus, and P aeruginosa lidocaine only and lidocaine with povidone-iodine groups. In these groups, each plate grew between 200 CFUs and 300 CFUs. In the Haemophilus influenza series, the lidocaine with povidone-iodine group had fewer CFUs than the control group. In all 4 series, the povidone-iodine only group had the least amount of CFUs, ranging from 0 to 6. CONCLUSIONS: The use of lidocaine gel before application of povidone-iodine 5% resulted in decreased effectiveness of antisepsis and increased microbial survivability. The increase in microbial survivability may increase the risk for postoperative infection in ocular surgery performed under topical anesthesia.

Treatment of traumatic LASIK flap dislocation and epithelial ingrowth with fibrin glue.

PURPOSE: To describe a case of a traumatic late dislocation of a laser-assisted in situ keratomileusis (LASIK) flap complicated by epithelial ingrowth. DESIGN: Interventional case report. METHODS: A 50-year-old woman presented 21 months after uncomplicated LASIK with painful vision loss in the right eye after minor trauma. RESULTS: A dislocation of the LASIK flap was noted at examination and was repositioned. One week later, epithelial ingrowth was detected in the flap interface. The ingrowth was treated with flap lifting, debridement, and sealing of the flap with fibrin glue. Visual acuity returned to baseline, and there was no recurrence after 20 months of follow-up. CONCLUSIONS: Traumatic dislocations of LASIK flaps may occur many months after uncomplicated surgery and may be associated with epithelial ingrowth after successful repositioning. The additional use of fibrin glue in conjunction with thorough debridement may be helpful in preventing the recurrence of epithelial ingrowth.

Lamellar interface fluid accumulation following traumatic corneal perforation and laser in situ keratomileusis.

A 41-year-old man with myopic astigmatism had laser in situ keratomileusis (LASIK) in each eye in April 2002. Ten months later, he sustained a central perforating corneal injury to the right eye. One day following repair of the corneal wound, he presented with diffuse corneal epithelial microcystic edema, lamellar interface fluid accumulation, and 20/400 visual acuity. Additional sutures were placed to close a presumed posterior wound gape with complete resolution of the corneal edema and lamellar interface fluid collection. One year later, his best corrected visual acuity measured 20/20+ in the right eye. This case is the first to document lamellar interface fluid accumulation following LASIK owing to traumatic disruption of the corneal endothelium.

Warm balanced salt solution for clearing tear film precipitation during cataract surgery.

Adequate anterior segment visualization during cataract surgery can be hindered when excessive tear film secretions precipitate on the corneal surface before the initial corneal incision is made. In most cases, room-temperature balanced salt solution applied to the corneal surface clears the debris. However, in cases in which tear film precipitates persist after the use of room-temperature balanced salt solution, the application of warm balanced salt solution can provide rapid and sustained dispersion of the precipitates. We present our experience using this technique.