Scoping Review Of Cataract Surgery Sterility: Data Gaps Linking Sustainability And Clinical Impact
Published 2026 - 44th Congress of the ESCRS
Reference: PP13.15 | Type: Free paper | DOI: 10.82333/8wef-jf75
Authors: Dr Zorana Lynton* 1 , Dr Abdullah Al-Ani 2 , Dr Brooklyn Rawlyk 2 , Dr Robert Moore 1 , Dr Michael Kryshtalskyj 2 , Dr Tara Klassen 3 , Ms Caitlin McClurg 4 , Dr Patrick Gooi 2 , Dr Paul Huang 2
1Cumming School of Medicine,University of Calgary,Calgary,Canada, 2Section of Ophthalmology,University of Calgary,Calgary,Canada, 3Surgery Strategic Clinical Network,Alberta Health Services,Edmonton,Canada, 4Libraries and Cultural Resources,University of Calgary,Calgary,Canada
Purpose
The clinical benefit of operating room (OR) sterility practices in preventing post-cataract infectious and inflammatory complications remains uncertain. Amid growing concerns about the environmental impact of surgical waste, this scoping review evaluates the clinical evidence on OR sterility practices in cataract surgery to identify potentially unnecessary practices that could be targeted for waste reduction.
Setting
PRISMA Scoping Review.
Methods
A comprehensive search following PRISMA guidelines was conducted across Embase, MEDLINE, Scopus, Web of Science, Cochrane, CINAHL, and ProQuest. Two independent reviewers screened studies for inclusion based on practice patterns, clinical efficacy related to infection or inflammation, or environmental impacts of antiseptic solutions, drapes, gloves, masks, and gowns in adult cataract surgery. Reports were included if they were in the English language and no time restrictions were applied. One investigator extracted data using a pilot-tested form.
Results
Of 3,360 records screened, 148 articles met the inclusion criteria. There were 83 (56%) experimental studies, 10 (7%) case reports/series, 24 (16%) surveys, 25 (17%) opinion-based articles or guidelines, and 6 (4%) economic/environmental evaluations. A meta-analysis of 1,608 eyes revealed that conjunctival povidone-iodine significantly reduced bacterial load on the ocular surface, potentially lowering the risk of endophthalmitis. Mask use was associated with a possible protective effect against infectious complications. In contrast, draping, gloving, and gowning were primarily discussed in opinion-based literature, comprising 40%, 38%, and 46% of reports on each practice, respectively.
Conclusions
Many OR sterility practices may not meaningfully impact clinical outcomes, yet contribute substantially to surgical waste. Conjunctival povidone-iodine and masks are supported by relatively more substantial evidence in cataract surgery. In contrast, drapes, gloves, and gowns lack robust clinical data and may contribute to avoidable environmental burden.