Takafumi Mori

Survey of Japanese ophthalmic surgeons regarding perioperative disinfection and antibiotic prophylaxis in cataract surgery

Purpose To elucidate Japanese trends for perioperative disinfection and antibiotic selection during cataract surgeries. Methods Perioperative iodine use and antibiotic prophylaxis for cataract surgery were surveyed in eight regions in Japan by mail or through interviews from February 1 to March 1, 2014. Results We surveyed 572 surgeons, of whom 386 (67%) responded. Most of the surgeons (94%) used iodine compounds before surgery for periocular skin disinfection (povidone–iodine [PI]: 79%; polyvinyl alcohol-iodine [PAI]: 15%) or conjunctival disinfection (85%; PI: 36%; PAI: 49%). Preoperative conjunctival iodine was primarily used as an eye wash (irrigation: 95%) and less often as an eye drop (5%). It was determined that 31% of surgeons waited 30 seconds or more between periocular disinfection and conjunctival disinfection. During surgery, 14% of surgeons used iodine several times, including immediately before intraocular lens insertion, and 7% used the Shimada technique (repeated iodine irrigation). Preoperative antibiotic eye drops were used by 99% of surgeons, and antibiotics were added to the irrigation bottle by 22%. The surgeons reported use of subconjunctival antibiotic injections (23%), antibiotic ointments (79%), and intracameral antibiotics (7%: 22 moxifloxacin; 6 levofloxacin). All surgeons prescribed postoperative eye drops, with 10% initiating the drops on the day of surgery. Conclusion Iodine compounds are commonly used preoperatively, but few institutions use iodine compounds intraoperatively, particularly with repeated application. The selection of antibiotic administration and disinfection technique has to be at the surgeon’s discretion. However, intracameral antibiotic and intraoperative iodine compound use are techniques that should be widely recognized.

Recovery of binocular responses by cortical neurons after early monocular lesions

A small lesion of the retina in one eye deprives normally binocular neurons in a sector of primary visual cortex of activating inputs from the lesioned eye, but not from the other, intact eye. Here we demonstrate that after monocular lesions early in life followed by years of recovery, deprived cortical neurons become robustly responsive to stimulation via new receptive fields in a zone of preserved retina around the retinal lesion, while maintaining receptive fields for the intact eye. These neurons respond similarly to comparable stimuli in two different locations, possibly producing a local diplopia or blur.

A Japanese Survey of Perioperative Antibiotic Prophylaxis in Cataract Surgery.

PurposeThe objective of this study was to identify trends in the use of perioperative antibiotic prophylaxis in cataract surgery in Japan. DesignThis was a national survey by mail or interview. MethodsThe use of perioperative antibiotic prophylaxis in cataract surgery was evaluated by conducting a survey in 6 regions within Japan from October 1, 2011, to March 1, 2012. ResultsResponses were received from 285 (75%) of the 387 surgeons who were surveyed. The results revealed that 89% (255/285) administered ophthalmic antibiotic ointment. Forty-seven percent (133/285) used antibiotics in forms other than ophthalmic ointments within 6 hours after surgery, 7% (19/285) used eyedrops, 24% (67/285) used antibiotics via an irrigation bottle, 1% (2/285) used intracameral injections, and 24% (69/285) used subconjunctival injections. ConclusionsAlthough poor intraocular penetration of ophthalmic ointments has been reported, ophthalmic ointments are widely used. The fact that antibiotics should ideally be administered within 6 hours after surgery is not widely recognized. However, intracameral injection, which achieves much higher antibiotic concentration in the anterior chamber than other methods, is a technique that should be widely acknowledged.