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Oakley, Carmen, MBBS, MOphthal*; Allen, Penny, PhD*,†; Hooshmand, Joobin, MBBS*; Vote, Brendan J. T., MBBS*

doi: 10.1097/IAE.0000000000001800
Original Study

Purpose: To investigate ocular bacterial count before and after antisepsis with aqueous chlorhexidine (AC) or povidone-iodine (PI) and to assess discomfort with each agent.

Methods: Bacterial swabs were taken from participants' eyes before and after antisepsis. These underwent microscopy, culture, and sensitivity testing. Aqueous chlorhexidine drops were administered to left eyes and PI to right eyes. Participants rated their pain (scale 0–10) for each eye but were blinded to the type of drop.

Results: There were 20 participants (17 women, 3 men), and the mean age was 43 years. Pain scores were significantly higher in right (PI) than in left (AC) eyes (mean 7 vs. mean 2, P < 0.001). No abnormalities were detected on specimen microscopy and gram staining. Seven preantisepsis swabs (three left and four right) grew bacteria in culture. Two postantisepsis swabs grew bacteria in primary culture plate (1 after AC and 1 after PI). For an additional one post-PI swab, bacteria were detected in enrichment broth only.

Conclusion: The efficacy of AC and PI are similar, and patient discomfort is lower with AC. Aqueous chlorhexidine is a good alternative to PI for antisepsis before intravitreal injection.

The antisepsis efficacy of povidone-iodine and aqueous chlorhexidine was similar. However, pain was significantly greater in eyes treated with povidone-iodine. The authors propose aqueous chlorhexidine as a good alternative to povidone-iodine for antisepsis before intravitreal injection.

*Tasmanian Eye Institute, South Launceston, Tasmania, Australia; and

Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.

Reprint requests: Penny Allen, PhD, Tasmanian Eye Institute, 36 Thistle Street West, South Launceston, Tasmania 2749, Australia; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.