Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

Abstract

Purpose of reviewEndophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface. Recent findingsPovidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy. SummaryPovidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrugresistant bacteria, fungi, and lack of inducible resistance. Keywords antisepsis, endophthalmitis, povidone-iodine]. An alternative povidone-iodine dosing scheme, the repetitive application of dilute povidone-iodine throughout surgery, could be helpful. We review the basic science, in vitro, and clinical data regarding this practice. Povidone-iodine is universally available, inexpensive, and the ocular surface is routinely washed with physiologic saline during many ophthalmic surgeries. These characteristics make the barriers to adopting frequent dilute povidone-iodine irrigation low. Therefore, surgeons' exposure to, and interpretation of the literature regarding this practice is particularly important. THE ROLE OF POVIDONE-IODINE IN THE PREVENTION OF OCULAR INFECTIONSNonpathogenic bacteria (resident bacteria) colonize the ocular surface and periocular skin. Under