Wang Yumeng et al. wrote in an article that endophthalmitis is the most serious complication of intraocular surgery . Once it occurs , it often leads to devastating consequences . Measures to prevent endophthalmitis include the use of antibiotic eye drops before and after surgery, preoperative eyelash trimming, tear duct irrigation, and antibacterial preparation of the surgical site with disinfectants such as povidone- iodine . A potential source of endometritis , a reduction in bacterial flora is associated with a lower incidence of postoperative infection . Povidone-iodine is the most commonly used antiseptic for intraocular surgery and has higher bactericidal activity against Gram-negative bacteria than against Gram-positive bacteria . A large number of studies have shown that povidone-iodine can significantly reduce the incidence of postoperative endophthalmitis , but povidone-iodine can cause a certain degree of ocular surface damage , such as ocular irritation symptoms, corneal epithelial exfoliation, corneal endothelial damage, and ocular surface damage. Inflammation, decreased tear film stability , etc. are closely related to the occurrence of perioperative dry eye , reduce the patient's visual quality , and are directly proportional to the concentration and duration of povidone-iodine . In addition , some patients may be allergic to iodine, which limits the application of povidone-iodine in ophthalmology . Therefore , it is necessary to find safer and more effective disinfectants for intraocular surgery to reduce patients’ postoperative ocular discomfort and relieve perioperative medical care. It can reduce the source of ocular surface damage and improve the patient's tolerance to surgery and visual effect. HOCL solution is a non-irritating, odorless, transparent, pH - neutral substance with powerful bactericidal activity . Research shows that hypochlorous acid has broad-spectrum antibacterial effects on bacteria, viruses, spores, and fungi . Hypochlorous acid solutions are widely used clinically . Currently it is mainly used to treat skin burns, ulcers, gingivitis, diabetic foot , etc. Hypochlorous acid is rarely used in ophthalmology . Preliminary studies have found that hypochlorous acid solution has significant efficacy in the treatment of bacterial and fungal keratitis without obvious adverse reactions . There are also articles indicating that hypochlorous acid can be used in the treatment of blepharitis and meibomian gland dysfunction . However, there are currently no reports of hypochlorous acid solution being used for preoperative disinfection during intraocular surgery . The study by Wang Meng et al. aimed to observe the anti-activity of conjunctival sac disinfection using 0.01% hypochlorous acid solution and 5% povidone-iodine before phacoemulsification and its impact on the stability of the tear film on the ocular surface . A preliminary evaluation was made at 0.01% times The application value of chloric acid as a preoperative disinfectant in ophthalmology .
The safety and effectiveness of 0.01% hypochlorous acid before phacoemulsification for cataract surgery has been supported by multiple studies. A controlled clinical trial was conducted on 285 patients scheduled for cataract surgery, who were randomly divided into hypochlorous acid and iodophenol groups. The results of the study showed that the use of 0.01% HOCL for conjunctival sac disinfection significantly reduced the positive bacterial culture rate and the colony-forming ability of the conjunctival sac, with a statistically significant difference compared with before disinfection (P<0.01), and hypochlorite The disinfection ability of acid is equivalent to that of iodophenol (χ2=0.811, P=0.368). In addition, the pain level and eye symptom scores of the hypochlorous acid group were significantly lower than those of the iodophenol group (P<0.01), and the corneal fluorescein staining and eye red index were also significantly lower than those of the iodophenol group (P<0.01). No patients in the two groups developed uveitis, indicating that 0.01% hypochlorous acid is safe and effective as a conjunctival sac disinfectant and causes minimal discomfort and damage to the patient's ocular surface.
It was further pointed out that although povidone-iodine is a commonly used disinfectant for intraocular surgery and can significantly reduce the incidence of postoperative endophthalmitis, it may cause a certain degree of ocular surface damage, which is related to perioperative dry eye. The occurrence is closely related to reducing the patient's visual quality. Therefore, it is particularly important to find safer and more effective disinfectants to reduce postoperative ocular discomfort and mitigate iatrogenic ocular surface damage. As a non-irritating, odorless, transparent, pH-neutral substance, hypochlorous acid solution has strong bactericidal activity and has been initially evaluated as having high application value as a preoperative disinfectant in ophthalmology.
Based on the above information, it can be concluded that the application of 0.01% hypochlorous acid as a conjunctival sac disinfectant before phacoemulsification is safe and effective. It not only has good antibacterial activity, but also causes less damage to the patient's ocular surface, helping to improve the patient's tolerance to surgery and visual effects.
Figure 1 Comparison of corneal fluorescein staining and NIBUT at different time points after disinfection between the two groups of patients CFS: corneal fluorescein staining score NIBUT: non-contact tear film breakup time
V1: 2 hours after disinfection V2: 1 day after disinfection V3: 1 week after disinfection
V1: Corneal epithelial damage was observed in both groups , with positive fluorescein staining , but was more severe in the povidone-iodine group .
NIBUT was also lower than that of the hypochlorous acid group V2: corneal epithelial flaky staining was still observed in the povidone-iodine group , while only a small amount of punctate staining was observed in the hypochlorous acid group. NIBUT also improved V3: Both groups
The corneal epithelium was almost completely repaired , but the NIBUT of the povidone-iodine group was still lower than that of the hypochlorous acid group.
The long-term safety and effectiveness of 0.01% hypochlorous acid before phacoemulsification of cataracts mainly focus on the following aspects:
Antimicrobial activity and effects on tear film stability on the ocular surface:
According to research in the "Operation Guidelines for Commonly Used Imaging Examination Equipment for Orbital Disease (2024)", 0.01% hypochlorous acid solution is used to disinfect the conjunctival sac before phacoemulsification. Studies have found that the solution has strong bactericidal activity and has less impact on the stability of the tear film on the ocular surface during the disinfection process, causing less discomfort to the patient and less damage to the ocular surface.
Reduce bacterial load and reduce antibiotic resistance:
Another study noted that 0.01% hypochlorous acid solution (HOCl) has been successfully used to disinfect skin and eyelids before eye surgery. Studies have shown that the use of HOCl solution significantly reduces the bacterial load without changing the diversity of bacterial species remaining on the lower eyelid skin, thereby eliminating the problem of resistance of certain strains to various antibiotics.
Reduce postoperative infectious complications:
In a study conducted by the Department of Ophthalmology of the Affiliated Hospital of Xuzhou Medical University, the use of hypochlorous acid aqueous solution for conjunctival sac disinfection was proven to be effective in killing bacteria and reducing the occurrence of povidone-iodine-related eye complications such as corneal epithelial damage. In addition, animal experiments have shown that no eye irritation symptoms occurred when topical eye drops of hypochlorous acid aqueous solutions with concentrations of 0.01%, 0.03%, and 0.1% were used.
Comparative study results between hypochlorous acid (HOCl) and other disinfectants (such as povidone-iodine PI) in pre-ophthalmic surgery disinfection show that hypochlorous acid has significant advantages.
First of all, from the perspective of antibacterial effects, both 0.01% biotype hypochlorous acid (HA) and 5% povidone-iodine (PI) can significantly reduce bacterial load in eye disinfection, but the average reduction value of hypochlorous acid is The PI is 7.1 times or 86% higher and non-irritating. This suggests that hypochlorous acid is more effective at reducing bacterial load in the eye.
Second, hypochlorous acid is less toxic to eye cells. For example, in one study, hypochlorous acid had no significant effect on the survival of conjunctival goblet cells (GCs), whereas 5% povidone-iodine significantly reduced the survival of these cells. This means that hypochlorous acid may be safer in reducing eye complications.
Additionally, hypochlorous acid has been shown to have advantages in wound healing. Studies have shown that stable hypochlorous acid solutions can enhance wound healing and have a powerful and rapid killing effect on different types of microorganisms and biofilms.
In summary, the application of hypochlorous acid in pre-ophthalmic surgery disinfection shows a more significant antibacterial effect and lower cytotoxicity than povidone-iodine, while having a positive impact on wound healing.
After using 0.01% hypochlorous acid to disinfect the conjunctival sac, the patient's ocular surface recovered well. According to research from the 982nd Hospital, after the observation group used 0.01% hypochlorous acid to flush the eyes, most of the conjunctival pseudomembranes disappeared on the 3rd day, and 84.78% of the conjunctival pseudomembranes disappeared on the 7th day. , the pseudomembrane completely disappeared in all patients by 14 days. In addition, some corneal lesions also began to disappear on the third day. By the seventh day, 37.5% of the corneal lesions had disappeared. By the 14th day, only one eye's corneal lesions had not disappeared.
As a natural and safe disinfectant, hypochlorous acid can significantly reduce the number of Staphylococcus bacteria on the skin around the eyes and reduce the risk of infection. This property makes hypochlorous acid uniquely advantageous in daily care and infection prevention.
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