PRACTICE PEARLS
From Ophthalmology 2008, presented by the University of California, San Francisco, School of Medicine, Beckman Vision Center, Department of Ophthalmology
Educational Objectives
| The goal of this program is to improve the practice of ophthalmology. After hearing and assimilating this program, the participant will be better able to: |
 | 1. Recognize the causes of potentially treatable blindness in children and discuss the effectiveness of povidone iodine in its prevention. |
| 2. Identify common ocular viral infections and manage them with appropriate diagnostic and therapeutic agents. |
| 3. Summarize the recent trends in litigation involving refractive surgeries and employ actions and behaviors to avoid legal claims. |
| 4. Implement effective strategies to manage the potential for itraoperative floppy iris syndrome in patients receiving medications such as selective α blockers. |
| 5. Choose the appropriate treatment and duration of treatment for amblyopia. |
Faculty Disclosure
In adherence to ACCME Standards for Commercial Support, Audio-Digest requires all faculty and members of the planning committee to disclose relevant financial relationships within the past 12 months that might create any personal conflicts of interest. Any identified conflicts were resolved to ensure that this educational activity promotes quality in health care and not a proprietary business or commercial interest. For this program, Dr. Abbott reported serving on the Board of Directors of OMIC, and Dr. Chang reported a consulting agreement with Advanced Medical Optics, Inc. Drs. Rutar, Margolis, and Horton, and the planning committee reported nothing to disclose.
Acknowledgements
Lectures for this program were recorded at Ophthalmology 2008, held December 12㪥, 2008, in San Francisco, CA, and presented by the University of California, San Francisco, School of Medicine, Department of Ophthalmology, Beckman Vision Center, San Francisco, CA. The Audio-Digest Foundation thanks the speakers and UCSF School of Medicine, Beckman Vision Center for their cooperation in the production of this program.
Povidone Iodine for the Treatment of Bacterial Keratitis in Children
Tina Rutar, MD, Assistant Professor, Department of Ophthalmology, Pediatric Ophthalmology and Strabismus, University of California, San Francisco, School of Medicine
| Epidemiology of childhood blindness: blindness occurs in 1.4 million children worldwide; untreatable in approximately one million (eg, retinal dystrophy, microphthalmus, cerebral visual impairment, optic atrophy or optic nerve hypoplasia); potentially treatable in 0.4 million (eg, corneal scarring, cataract, retinopathy of prematurity); regional and socioeconomic differences—primary causes in developed countries include retinal (retinopathy of prematurity), optic nerve (hypoplasia), and disorders of higher visual pathway (cerebral visual impairment); worldwide, bacterial corneal ulcers and scarring cause most avoidable childhood blindness (eg, 260,000 cases of blindness caused by scarring); predisposing conditions include trachoma, vitamin A deficiency, and ocular trauma; bacterial keratitis leads to corneal scarring and perforation |
| Strategies to decrease blindness caused by corneal scarring: eliminate predisposing conditions; vaccinate against measles; encourage use of protective eyewear; educate to reduce use of harmful traditional medications; provide prophylaxis for ophthalmia neonatorum to all newborns |
| Povidone iodine treatment for infectious keratitis: effective in preoperative preparation; in ophthalmology, also effective for postoperative prophylaxis, prevention of ophthalmia neonatorum, and treatment of bacterial conjunctivitis |
| Clinical study: randomized double-blind controlled trial conducted in India and Philippines of 1.25% solution of povidone iodine vs ciprofloxacin or neomycin, polymyxin, and gramicidin (Neosporin); 172 patients (156 adults and 16 children) enrolled |
| Pediatric participants: 7 randomized to povidone iodine and 9 to antibiotic arms; nurses administered drops every hour for first 3 days; later, medications tapered according to protocol |
| Primary outcome measure: probability of cure depended on rate of cure (closed epithelial defect with minimal conjunctival injection) and time to cure; other measures included rates of improvement, worsening, and failure |
| Results: 71% of children treated with povidone iodine achieved cure (vs 44% with antibiotics); cure or improvement seen in 82% of children treated with povidone iodine, compared to 89% with antibiotics; cure achieved in 6 days with povidone iodine vs 7 days with antibiotics; worsening on treatment observed in 1 child who received povidone iodine; 1 child failed treatment with ciprofloxacin |
| Outcome: in study including all 172 participants, patients treated with povidone iodine did as well as those treated with antibiotics |
| Other differences between children and adults: order of prevalence of bacterial species (ie, Pseudomonas, Streptococcus pneumoniae, and Moraxella in pediatric patients; Moraxella, Pseudomonas, and Streptococcus in adults); ulcer characteristics—pediatric patients had smaller stromal defects and hypopions than adults
I have long treated my patient's eye infections with Betadine. It speeds up the treatment. I recommend this to all of my patients. |
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