Can Avenova Reduce Surgical Infection?

Used on the lid margins before surgery, pure hypochlorous acid has the potential to reduce complications.

■ By Terrence P. O’Brien, MD

As we know, lid bacteria are the enemy of the ocular surgeon and the entire eyecare team. If we evaluate infections occurring after refractive surgery, the most common culprits are Staphylococcus, methicillin-resistant Staphylococcus aureus and Streptococcus.^1-4 There can be exogenous contaminants such as mycobacteria, but now that we’re aware of those risk factors, the most common bacterial causes of infection after refractive surgery are the Grampositive organisms.

This list of common bacterial infections mirrors the bacteria that we recover from the lid margins and ocular surface. One way to help prevent infection after surgery is to reduce the flora in and around the eye preoperatively.

Post-PRK Staph Infection

A patient who had undergone photorefractive keratectomy (PRK) was taking a flight home, when his bandage contact lens became a bit dry. He went into the lavatory on the aircraft, rinsed the lens and put it back on the eye.

Not long after the patient arrived at home, signs of infection appeared. He had severe, ulcerative keratitis with stromal infiltrate and hypopyon. The cultures grew heavy Staphylococcus aureus. Despite extensive, aggressive treatment, he had residual corneal scarring and opacification.

Severe Strep Infection

As devastating as it is to have an infection with elective surgery such as PRK or LASIK, it’s even more dangerous to encounter an infection after an intraocular procedure. Certainly, endophthalmitis after ocular surgery is a nightmare for any eye surgeon.

A number of years ago, a landmark paper by Speaker and colleagues⁵ confirmed that the patient’s own flora are most frequently implicated as causative organisms in endophthalmitis: “The source of infecting bacteria is often unknown in postoperative endophthalmitis. Using techniques of molecular epidemiology, the authors demonstrate that an organism isolated from the vitreous was genetically indistinguishable from an isolate recovered from the patient’s eyelid, conjunctiva, or nose in 14 (82%) of 17 cases of endophthalmitis….”

One patient developed a severe Streptococcus infection after a combined phacoemulsification with posterior chamber intraocular lens implantation and trabeculectomy. The result was severe suppurative endophthalmitis with hypopyon and fibrinous aqueous. Despite aggressive treatment, the patient had severe and permanent loss of visual acuity.

Preventing infection

Knowing that the eyelids are one source of infectious organisms in refractive procedures as well as intraocular procedures, it’s crucial that we attempt to reduce colonization prior to these surgeries.

As an ophthalmic surgeon, I’m excited to have pure hypochlorous acid (Neutrox, the active ingredient in Avenova by NovaBay). This natural killer can be used to manage and reduce microbial colonization before ocular surgical procedures in order to reduce the likelihood of infection.

Preoperative application of hypochlorous acid is a theoretical but very rational use of this product. I think in time, after we have the opportunity to gain greater experience using Avenova for presurgical lid hygiene, we will see it emerge as a very important tool that can not only treat blepharitis and MGD, but also play a perioperative role in controlling blepharitis to reduce potential serious eye infections. ●

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