Scoping Review of Cataract Surgery Sterility: Data Gaps Linking Sustainability and Clinical Impact

Background: Sterility practices in the cataract operating room (OR) are adopted to reduce the risk of complications. However, their clinical effectiveness remains uncertain, while their contribution to OR waste and carbon emissions is well established. Objectives: To conduct a scoping review examining the global diversity, clinical evidence, and environmental impact of antiseptics, drapes, gloves, masks, and gowns in adult cataract surgery. Eligibility criteria: Reports in the English language on perioperative sterility practice patterns, clinical efficacy related to infection or inflammation, or environmental impacts of adult cataract surgery without time restrictions. Sources of evidence: Searches were conducted across Embase, MEDLINE, Scopus, Web of Science, Cochrane Library, CINAHL, and ProQuest Dissertations & Theses Global. Charting methods: Two reviewers independently screened records, and 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. In contrast, draping, gloving, and gowning were primarily discussed in opinion-based literature, comprising 40%, 38%, and 46% of reports on each practice, respectively. Conclusion: 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.