OP Guidelines ONO

Disinfection in the operating room

Disinfectants

• Betadine^® Solution: povidone-iodine 10% (=betadine^® pure -> standard solution which can be further diluted)
• hibidil^® Solution: chlorhexidine digluconate 0.05%
• Octenisept^® Solution: octenidine dihydrochloride 0.1% and phenoxyethanol 2%
• desomedine^® Eye Drops: Hexamidini Diisetionas

Dilution solution

• BSS (Balanced Salt Solution) -> better tolerated than NaCl 0.9% when used ocularly

Eye lids

skin

• hibidil^® Pure solution
• Betadine^® Pure solution
• For iodine allerics: Octenisept^® Pure solution

Intravitréal injections (IVI)

• hibidil^® Pure solution
• Betadine^® 1% solution, diluted (1 ml Betadine + 9 ml BSS)
  
  • Application
    
    • 1x through patient preparation before surgery
    • 1x by operating room staff during storage
    • Rinse once after covering then wait 30 seconds, then rinse with BSS
      
• In the case of iodine allergy: desomedine^® Eye drops twice during preparation, then once in surgery

Intraocular procedures (cataract surgery, glaucoma surgery, vitreoretinal surgery)

Skin, eyelids, eyelashes

• hibidil^® Pure solution
  
• Betadine^® Pure solution
• In Case of Iodine Allergy: Octenisept^® Pure solution

conjunctival sac, cornea

• hibidil^® Pure solution
• Betadine^® 5% solution, diluted (1 ml Betadine^® + 1 ml BSS)
• In the case of iodine allergy: desomedine^® Eye Drops Twice in Preparation, Then Once in Surgery

Refractive corneal surgery (LASIK, PRK, crosslinking)

• hibidil^® Pure solution
• Betadine^® 1% solution, diluted (1 ml Betadine^® + 9 ml BSS)

‍
sources:

• ‍ESCRS Guidelines for Cataract Surgery, as of 12/2025
• Blaubuch University Clinic for Ophthalmology Bern 11/224

Mitomycin C (MMC)

Alkylating cytostatic -> inhibits cell proliferation (e.g. during scarring)

• Wear gloves and goggles when preparing MMC
• MMC solution must be clear and bluish if it remains cloudy -> discard
• Remnants of MMC and utensils that were in contact with MMC -> Dispose of them properly
• In case of skin or eye contact, rinse thoroughly immediately

PTK/PRK

• 10 ml NaCl 0.9% in 1 ampoule of mitomycin 2 mg = 0.2 mg/ml = 0.02%
• Instructions
  
  • Wear safety goggles and gloves
  • Remove the MMC cover and desinfect with alcohol wipe
  • Pierce mini spike
  • Draw up 10 ml NaCl 0.9% and add to the MMC ampoule

glaucoma surgeries (TS, TE, Needling, PreserFlo)

• 5 ml NaCl 0.9% in 1 ampoule of mitomycin 2 mg = 0.4 mg/ml = 0.04%
• Instructions
  
  • Wear safety goggles and gloves
  • Remove the MMC cover and desinfect with alcohol wipe
  • Pierce mini spike
  • Draw up 5 ml NaCl 0.9% and add to the MMC ampoule
• Needling
  
  • Concentration 0.2 mg/ml (0.4 mg/ml only if there is an increased risk of scarring)
  • Dosis 0.1 ml
  • Place of Application (not directly into the bleb)