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Teren D, Neuman G, Abulafia A, Gelman E, Assayag E, Hajj A, Shwartz O, Zadok D. In vivo assessment of antimicrobial activity and toxicity of repeated 1% povidone-iodine applications vs a single 5% povidone-iodine application. J Cataract Refract Surg 2024; 50:682-687. [PMID: 38477800 DOI: 10.1097/j.jcrs.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. SETTING Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN Prospective, randomized, double-blind study. METHODS Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. RESULTS The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application ( P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI ( P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application ( P < .001). CONCLUSIONS Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.
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Affiliation(s)
- David Teren
- From the Department of Ophthalmology, Shaare Zedek Medical Center, affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel (Teren, Neuman, Abulafia, Gelman, Assayag, Zadok); Microbiology and Immunology Laboratory, Wolfson Medical Center, Holon, Israel (Hajj, Shwartz)
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Casemiro JH, Oguido APMT, Casella AMB. Using 2% PVPI topical solution for serial intravitreous injections and ocular surface findings: a case control study. Int J Retina Vitreous 2024; 10:41. [PMID: 38812063 PMCID: PMC11134966 DOI: 10.1186/s40942-024-00557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The use of povidone-iodine for ocular surface asepsis is widespread for intravitreal injections. They became frequent procedures, leading to serial exposure of patients' eyes to iodinated solutions. In this study, we investigate the changes in the ocular surface in patients submitted to repeated use of povidine for intravitreal injection of anti-VEGF asepsis, analyzing Ocular Surface Disease Index, non-invasive break up time, blinking quality, lipid layer, meniscus height and osmolarity. METHODS This case-control study included 34 individuals (68 eyes), 14 males, 20 females aged 48 to 94. Inclusion criteria were individuals who received application of 2% povidone-iodine eyedrops for intravitreal injections treatment with the non-treated contralateral eye used as control. Ocular surface examinations were performed at a single occasion. A pre-intravitreal injection asepsis protocol with povidone-iodine was applied. All statistical analysis was performed using the STATA® 18.0 Software and a p-value = 0.05 was considered as the statistical significance value in all tests. RESULTS The median number of IVIs in treated eyes was 12 (range 6-20). The results in treated eyes compared with untreated eyes were respectively : median OSDI 16 (IQR 6-39) and 12.5 (IQR 8-39) (p = 0.380); mean NIBUT 10.30 (SD ± 2.62) and 10.78 (SD ± 2.92) ( s, p = 0.476); median blinking quality 100 (IQR 100) and 100 (IQR 100 ) (%, p = 0.188); median lipid layer 87 (IQR 77-90) and 86 (IQR 74-100) (nm, p = 0.451); median meniscus height 0.22 (IQR 0.19-0,31) and 0.24 (IQR 0.20-0.27) (mm, p = 0.862), median Meibomian gland atrophy 33 (IQR 24-45) and 31.5 (IQR 25-39) (%, p = 0.524); and mean osmolarity 306.6 (SD ± 21.13) and 313.8 (SD ± 29) (mOsm, p = 0.297). There was no statistically significant relationship between the repetitive use of 2% iodinated solution and signs or symptoms compatible with dry eye syndrome in this group of patients. CONCLUSIONS The findings suggest that 2% povidone iodine is a safe and efficacious agent for ocular surface antisepsis during intravitreal injections, not leading to substantial ocular surface modifications. This conclusion supports the continued use of povidone iodine in routine ophthalmic procedures without increased risk of inducing dry eye syndrome.
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Affiliation(s)
- José Henrique Casemiro
- Postgraduate Program in Health Sciences, State University of Londrina, UEL, Londrina, Brazil
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Foja S, Heinzelmann J, Viestenz A, Rueger C, Hecht S, Viestenz A. Evaluation of the Possible Influence of Povidone Iodine (PVI) Solution and Polyhexanide (PHMB) on Wound Healing in Corneal Epithelial Regeneration. J Clin Med 2024; 13:588. [PMID: 38276094 PMCID: PMC10816162 DOI: 10.3390/jcm13020588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
This study investigates the possible toxic effects of the preoperative antiseptic substances povidone iodine (PVI) and polyhexanide (PHMB; Serasept® 2) on wound healing in ophthalmology. To assess this impact, human telomerase-immortalized corneal epithelial (hTCEpi) cells and human telomerase-immortalized conjunctival epithelial (hCjE) cells were exposed to 1% and 5% PVI or 0.04% PHMB for different periods to evaluate the cytotoxicity of these two antiseptics. Furthermore, the toxicity of these antiseptics was investigated in a human tissue-specific corneal epithelial construct and porcine eye culture model. The results reveal the high cytotoxicity of PVI and PHMB in the hTCEpi and hCjE in monolayer cell culture models, independent of the incubation time and concentration of these substances. However, after hTCEpi cell differentiation into a tissue-specific corneal epithelial construct, contact with these antiseptics for the relevant preoperative time did not alter cPARP1 or Ki67 expression. Furthermore, the wound-healing process in the porcine cornea was not significantly influenced after incubation with these antiseptics. In summary, corneal and conjunctival epithelial cell lines are very sensitive to PVI and PHMB, whereas no significant alterations were found in intact tissue-specific corneal epithelial constructs or porcine corneas. Therefore, we could not identify PVI and PHMB as reasons for postoperative eye irritation.
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Prucha VJ, Egerbacher M, Tichy A, Nell B. Effects of diluted povidone iodine on viability and migration of canine corneal epithelial and stromal cells in tissue culture. Res Vet Sci 2022; 151:1-9. [DOI: 10.1016/j.rvsc.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022]
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Kanclerz P, Myers WG. Chlorhexidine and other alternatives for povidone-iodine in ophthalmic surgery: review of comparative studies. J Cataract Refract Surg 2022; 48:363-369. [PMID: 34538779 DOI: 10.1097/j.jcrs.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
Povidone-iodine (PVI) is a universally accepted antiseptic agent used in ophthalmic surgery. Insufficient antisepsis in patients with self-reported allergies to iodine has led to devastating complications. The aim of this study was to review the current evidence for alternatives to PVI in ocular surgery. Aqueous chlorhexidine has been used as a primary antiseptic agent in Sweden for several years and has proven efficiency and safety; in a study of a large series of intravitreal injections in Australia, the endophthalmitis rates were similar to those after the use of PVI. The evidence related to using other disinfectants such as picloxydine, hypochlorous acid solution, and polyhexanide is scarce. Single studies have shown lower patient discomfort after conjunctival lavage with chlorhexidine or hypochlorous acid than with PVI. No evidence was found to suggest changing from PVI to other antiseptic agents. Disinfectant solutions other than PVI or chlorhexidine will require further investigations to show their utility in ocular surgery.
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Affiliation(s)
- Piotr Kanclerz
- From the Hygeia Clinic, Gdańsk, Poland (Kanclerz); Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland (Kanclerz); Northwestern University, Chicago, Illinois (Myers)
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Grzybowski A, Shimada H, Nakashizuka H, Koerner J. Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery. Curr Opin Ophthalmol 2022; 33:28-34. [PMID: 34720096 DOI: 10.1097/icu.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Endophthamitis 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 FINDINGS Povidone-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. SUMMARY Povidone-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 multidrug-resistant bacteria, fungi, and lack of inducible resistance.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn
- Institute for Research in Ophthalmology, Poznan, Poland
| | - Hiroyuki Shimada
- Department of Ophthalmology, School of Medicine, Nihon University, Japan
| | | | - Jagger Koerner
- Department of Ophthalmology, Wake Forest Baptist Health, Wake Forest University, USA
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Potential substitutes for povidone-iodine in ocular surgery. Eye (Lond) 2021; 35:2657-2659. [PMID: 33594245 PMCID: PMC8452696 DOI: 10.1038/s41433-021-01447-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/17/2020] [Accepted: 01/27/2021] [Indexed: 02/04/2023] Open
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Effect of topical povidone-iodine 10% plus levofloxacin 0.5% 1 hour before cataract surgery in eliminating perioperative conjunctival flora: randomized clinical trial. J Cataract Refract Surg 2021; 47:340-344. [PMID: 32947383 DOI: 10.1097/j.jcrs.0000000000000436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of a single administration of topical povidone-iodine (PVI) 10% plus levofloxacin 0.5% at 1 hour before cataract surgery on perioperative elimination rate of conjunctival flora. SETTING Poostchi Ophthalmology Research Center, Shiraz, Iran. DESIGN Randomized controlled trial. METHOD Patients who required cataract surgery were randomly assigned to 1 of 2 groups: intervention (administration of PVI 10% plus levofloxacin 0.5% at 1 hour preoperatively) or control. The patients in both groups received PVI just before the operation. Conjunctival cultures were obtained using thioglycollate broth at 4 timepoints: T1, before intervention; T2, before the second application of PVI; T3, 3 minutes after the second administration of PVI; and T4, just postoperatively. RESULTS The study comprised 142 patients. The comparative rates of positive cultures in the intervention vs control groups were as follows: T1 (70.4% vs 73.2%, P = .709); T2 (15.5% vs 71.8%, P < .001); T3 (7.0% vs 19.7%, P = .027); and T4 (5.6% vs 4.2%, P = .698). Coagulase-negative Staphylococci was the most common isolated microorganism. CONCLUSIONS Results showed that a single adjuvant application of PVI 10% plus levofloxacin 0.5% eyedrops at 1 hour before operation leads to a further increase in the rate of sterile conjunctiva just preoperatively.
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Review, analysis, and education of antiseptic related ocular injury in the surgical settings. Ocul Surf 2021; 22:60-71. [PMID: 34224865 DOI: 10.1016/j.jtos.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
Preoperative skin antiseptic preparation is the gold standard for prevention of surgical infection. However, improper use of antiseptics may lead to severe ocular damage. Currently, the most common surgical antiseptics can be divided into aqueous-based and alcohol-based disinfectants, with chlorhexidine and iodine/iodophors being the two major components. Chlorhexidine has a persistent antimicrobial effect and is resistant to neutralization by blood or organic products in surgical wounds. Nevertheless, due to its toxicity to the ears, meninges, and eyes, application of chlorhexidine should be prohibited in these surgical fields. Iodine/iodophor is better tolerated by the ocular surface and is the recommended antiseptic for ophthalmic or head and neck surgeries close to the periocular area. Alcohol is less pricey and has a rapid antiseptic effect, though its desiccating effect and flammability restrict the use in mucosal or laser surgeries. The single or combined use of these antiseptics may inadvertently induce severe ocular damage, especially during time-consuming head and neck surgeries with prone, hyperextension, or lateral tilt positions, or surgeries under general anesthesia. Apart from the choice of antiseptics, appropriate selection and attachment of bio-occlusive dressings are key to avoiding antiseptic-related ocular injuries. In this review, we provided a comprehensive summary of the characteristics of antiseptics used in surgical settings and the possible mechanisms and outcomes of antiseptic-related ocular injuries. The prevention, diagnosis, and acute management of these complications were also discussed.
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Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study. J Clin Med 2021; 10:jcm10102198. [PMID: 34069600 PMCID: PMC8160713 DOI: 10.3390/jcm10102198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery; the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM®) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure.
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Lee S, Khun D, Kumarasinghe GL, De zoysa GH, Sarojini V, Vellara HR, Rupenthal ID, Thakur SS. Ex vivo evaluation of the stability, safety and antibacterial efficacy of an extemporaneous povidone‐iodine preparation for ophthalmic applications. Clin Exp Optom 2021; 102:583-589. [DOI: 10.1111/cxo.12899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/17/2019] [Accepted: 03/01/2019] [Indexed: 01/29/2023] Open
Affiliation(s)
- Stephen Lee
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
| | - Darina Khun
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
| | - Gamith L Kumarasinghe
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
| | - Gayan H De zoysa
- School of Chemical Sciences, The University of Auckland, Auckland, New Zealand,
| | | | - Hans R Vellara
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
| | - Sachin S Thakur
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand,
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Khan MM, Parab SR. 0.5% povidone iodine irrigation in otorhinolaryngology surgical practice during COVID 19 pandemic. Am J Otolaryngol 2020; 41:102687. [PMID: 32861125 PMCID: PMC7437506 DOI: 10.1016/j.amjoto.2020.102687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/13/2020] [Indexed: 01/12/2023]
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Kanclerz P, Myers WG. Comment on: A Prospective, Randomized Trial of Povidone-Iodine 0.6% and Dexamethasone 0.1% Ophthalmic Suspension for Acute Bacterial Conjunctivitis. Am J Ophthalmol 2020; 218:353. [PMID: 32826035 DOI: 10.1016/j.ajo.2020.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
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Khan MM, Parab SR, Paranjape M. Repurposing 0.5% povidone iodine solution in otorhinolaryngology practice in Covid 19 pandemic. Am J Otolaryngol 2020; 41:102618. [PMID: 32574894 PMCID: PMC7301800 DOI: 10.1016/j.amjoto.2020.102618] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023]
Abstract
SARS CoV 2 is very much homologous in structure to SARS CoV. Review of literature suggests the in-vitro virucidal action of povidone iodine in SARS CoV and MERS. The oropharynx and nasopharynx are target sites of SARS CoV 2. A significant proportion of COVID 19 sufferers are asymptomatic, but shedding these viral particles, PVP-I has been shown to be a safe therapy when used as a mouthwash or taken nasally or used during ophthalmic surgeries. AIMS MATERIALS AND METHODS: 0.5% PVP-I solution is prepared from commercially available 10% PVP-I solution. Patients were instructed to put 0.5% PVP-I drops in nose and rinse mouth with gargle prior examinations for 30 s. For endoscopic procedure (nasal and throat) nasal douching and gargling to be started one day prior. Douching and rinsing to be repeated just before procedures. Nasal packing with 0.5% PVP-I along with 4% xylocaine/adrenaline solution, tolerability and any allergic reaction noted. RESULTS The patient and health care workers tolerated the 0.5%. No allergy was noted. CONCLUSION We propose the use of 0.5% PVP-I in healthcare workers and their patients to minimise the risk of spread of the disease in addition to the recommended PPE.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan's ENT Research Center, Talegaon Dabhade, India.
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Gnanasekaran S, Rogers S, Wickremasinghe S, Sandhu SS. Response to correspondence from Koerner and colleagues concerning our paper entitled: The effect of diluting povidone-iodine on bacterial growth associated with speech. BMC Ophthalmol 2020; 20:328. [PMID: 32787799 PMCID: PMC7425590 DOI: 10.1186/s12886-020-01599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
Clinicians adopt varying strategies for antisepsis with PI, which to this day remains efficient, economical and effective. Clinicians should prudently consider effective PI application, and we thank Koerner and Grzybowski for encouraging debate and raising the profile of this issue.
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Affiliation(s)
- Sivashanth Gnanasekaran
- Centre For Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia.
| | - Sophie Rogers
- Centre For Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia
| | - Sanj Wickremasinghe
- Centre For Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia
| | - Sukhpal S Sandhu
- Centre For Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria, 3002, Australia
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Koerner J, Grzybowski A. Povidone-iodine pharmacokinetics and study design. BMC Ophthalmol 2020; 20:29. [PMID: 31952486 PMCID: PMC6969449 DOI: 10.1186/s12886-020-1313-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/10/2020] [Indexed: 01/18/2023] Open
Abstract
Dr. Gnanasekaran et al. reported the bactericidal activity of various concentrations of povidone iodine (PI) solution in an agar plate experiment of respiratory flora. The study design and the pharmacokinetic properties of PI solution ensured that dilute PI would not be effective in this study. These results may not replicate the typical clinical situation and are significantly different than a previously reported agar plate experiment, again owing to subtle but very significant differences in methodology.
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Affiliation(s)
- Jagger Koerner
- Department of Ophthalmology, Wake Forest University, Winston Salem, USA.
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
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Preoperative topical liposomal ozone dispersion to reduce bacterial colonization in conjunctival sac and periocular skin: Preliminary study in dogs. Exp Eye Res 2019; 189:107848. [PMID: 31634477 DOI: 10.1016/j.exer.2019.107848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
Prophylaxis represents a keystone to reduce periocular skin and ocular conjunctiva bacterial load before surgical procedures. Despite many prophylactic agents are available the preferred perioperative ocular surface antimicrobial is still unknown. The purpose of this study was to assess the effectiveness of preoperative liposomal ozone dispersion in reducing bacterial colonization from the conjunctival sac and periocular skin in dogs, in comparison with povidone-iodine and fluoroquinolone. Twenty-two owned dogs consisting with 44 eyes in total scheduled for ophthalmic surgical procedure were enrolled for the study and divided in four groups receiving either ozone dispersion or povidone iodine in eyelid and conjunctiva, fluoroquinolone or placebo. A swab was taken before and after the antisepsis protocol evaluating total microbial count, coagulase positive and negative staphylococci. Statistical analysis revealed a significant decrease in colony forming units (CFU) for total microbial count, coagulase positive and negative staphylococci both for liposomal ozone dispersion and povidone iodine. No statistical differences were detected in median CFU for both one-day placebo and fluoroquinolone preoperative prophylactic topical therapy. The results of this preliminary study demonstrate that liposomal ozone-dispersion is as effective as povidone iodine to reduce preoperative bacterial load in ocular surface.
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Moser CL, Lecumberri Lopez M, Garat M, Martín-Baranera M. Prophylactic intracameral cefazolin and postoperative topical moxifloxacin after cataract surgery: endophthalmitis risk reduction and safety results in a 16-year study. Graefes Arch Clin Exp Ophthalmol 2019; 257:2185-2191. [DOI: 10.1007/s00417-019-04417-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022] Open
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Musumeci R, Bandello F, Martinelli M, Calaresu E, Cocuzza CE. In vitro bactericidal activity of 0.6% povidone-iodine eye drops formulation. Eur J Ophthalmol 2018; 29:673-677. [PMID: 30295039 DOI: 10.1177/1120672118802541] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the bactericidal activity of a diluted povidone-iodine formulation (0.6%) in comparison with the most used 5% povidone-iodine solution ophthalmic preparation. METHODS In vitro bactericidal activity comparison between 0.6% povidone-iodine versus 5% povidone-iodine formulations, against these bacteria: Staphylococcus aureus ATCC 25923, Staphylococcus aureus ATCC 43300, Staphylococcus epidermidis ATCC 12228, linezolid-resistant Staphylococcus epidermidis α99 strain, a clinical isolate, Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922. RESULTS About 0.6% povidone-iodine formulation was demonstrated to be faster than 5% povidone-iodine preparation in killing Gram-positive as well as Gram-negative bacteria. Against a linezolid-resistant methicillin-resistant Staphylococcus epidermidis strain, 0.6% povidone-iodine formulation showed the best antiseptic efficacy requirement of 3-log10 reduction in bacterial load, if compared with the 5% povidone-iodine formulation. CONCLUSION Our investigation has demonstrated that the more diluted 0.6% preparation was more rapidly bactericidal than the 5% povidone-iodine formulation, most probably due to the fact that dilution from 5% to 0.6% increases the amount of free iodine. While our finding must be confirmed by in vivo clinical studies, this fact constitutes an intriguing news for what concerns the use of povidone-iodine eye drops in the ocular surface treatment before intravitreal injections as well as ophthalmic surgery.
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Affiliation(s)
- Rosario Musumeci
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Marianna Martinelli
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Enrico Calaresu
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Clementina Elvezia Cocuzza
- Laboratory of Clinical Microbiology and Virology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Wass S, Albrektsen G, Ødegård MT, Sand M, Austeng D. Antiseptic effect of low-concentration povidone-iodine applied with a depot device in the conjunctiva before cataract surgery. Eye (Lond) 2018; 32:1900-1907. [PMID: 30171195 PMCID: PMC6292903 DOI: 10.1038/s41433-018-0198-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 06/12/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose Examine the antiseptic effect of long-term low-concentration (0.3%) povidone-iodine (PI) before cataract surgery. Setting St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. Design Single-armed prospective clinical study. Methods Repeated measure of preoperative conjunctival samples from 51 participants were obtained the day before surgery (T1), the day of surgery after treatment with ophthalmic NSAID (T2), and after additional treatment with low-concentration PI (T3) given by placing a pledget soaked in a mix of eye-drops in fornix inferior for 20 min. Results Before surgery, and before any type of treatment (T1), bacterial growth (≥5 BC) in the conjunctiva was identified in 36 (66.7%) of the participants. After treatment with ophthalmic NSAID (T2), and after additional treatment with low-concentration PI (T3), bacteria were identified in 31 (60.8%) and 12 (23.4%) participants, respectively. All except one of the participants with a measurable change from T2 to T3 (n = 31, 60.8% of total sample), experienced a decrease in number of bacterial colonies (BC) after treatment with low-concentration PI (96.8 vs. 3.2%, p < 0.001). A complete removal of bacteria was seen in 20 (n = 31, 64,5%) of the colonized participants after treatment with PI. Conclusions Preoperative treatment with long-term, low-concentration PI applied via a depot device in fornix inferior, seem to be an easy and effective way to reduce the number of BC in the conjunctiva.
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Affiliation(s)
- Simon Wass
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Grethe Albrektsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria Tjåland Ødegård
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mari Sand
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Dordi Austeng
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Koerner JC, George MJ, Meyer DR, Rosco MG, Habib MM. Povidone-iodine concentration and dosing in cataract surgery. Surv Ophthalmol 2018; 63:862-868. [PMID: 29778494 DOI: 10.1016/j.survophthal.2018.05.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/26/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
Abstract
Iodine has been recognized as an effective bactericide since the 1800s, and povidone-iodine (PI) solution has been applied to the ocular surface and periocular skin since the 1980s to prevent endophthalmitis in cataract surgery. In vitro, PI solution kills bacteria quickly at dilute concentrations (0.05%-1.0%). In many instances, PI kills bacteria more quickly at these dilute concentrations than more conventional (5%-10%) concentrations. This is due to greater availability of diatomic free iodine in dilute solution, the bactericidal component of PI. The toxicity of PI, both in vitro and clinically, has been shown to be related to concentration. Current American Academy of Ophthalmology and the European Society of Cataract and Refractive Surgeons recommendations regarding PI use suggest using 5% PI before surgery. An alternative dosing strategy uses dilute PI repetitively throughout cataract surgery (0.25% every 30 seconds). We review the povidone-iodine literature with attention to basic science and use of dilute PI.
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Affiliation(s)
- Jagger C Koerner
- The Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, New York, USA.
| | - Mary J George
- Albany Medical College, Department of Microbiology, Albany, New York, USA
| | - Dale R Meyer
- The Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Michael G Rosco
- The Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, New York, USA
| | - Matthew M Habib
- The Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, New York, USA
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Abstract
PURPOSE OF REVIEW Povidone-iodine (PVI) is a disinfectant and antiseptic agent used for preoperative preparation of the skin and mucous membranes, as well as for the treatment of contaminated wounds. Currently regimens for prophylaxis against postsurgical endophthalmitis are being modified, including a total withdrawal of antibiotics in intravitreal injections. The aim of this study was to evaluate the use of PVI in ophthalmology. RECENT FINDINGS As a result of its broad spectrum of microbicidal activity, PVI is routinely used in ophthalmic surgery. However, various protocols are applied worldwide and within different procedures. Additional indications include prophylaxis against ophthalmia neonatorum, acute conjunctivitis, adenoviral conjunctivitis, bacterial keratitis or corneal ulcer, endophthalmitis, giant fornix syndrome, and antimicrobial prophylaxis in patients with Boston type I keratoprosthesis. SUMMARY Despite the introduction of new antiseptics in surgery, PVI is still the preeminent antiseptic measure in ophthalmology. Its use is economically reasonable. There have been no reports of resistance to PVI or anaphylaxis with topical ophthalmic use. Furthermore, it does not induce resistance or cross-grztance to antibiotics. With these advantages the range of indications for topical use of antibiotics might decrease, with PVI as the sole perioperative antiseptic measure. Additional studies are required to assess the optimal timing, concentration and exposure time within different ophthalmic procedures.
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Comparative efficacy of two different topical povidone-iodine 5% regimens in reducing conjunctival bacterial flora: A randomized parallel double-masked clinical trial. PLoS One 2017; 12:e0189206. [PMID: 29261737 PMCID: PMC5736199 DOI: 10.1371/journal.pone.0189206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The increasing prevalence of multi-resistant bacteria is a major public health concern. Infections acquired during ophthalmic surgery are devastating. The purpose of the current study is to compare the proportion of eyes with negative bacterial cultures on all tested media after 1 versus 3 sequential drops of povidone-iodine (PI) 5% into the inferior conjunctival fornix. METHODS Patients were randomly assigned to receive 1 (PI group) drop (at time 28 minutes) or 3 (PI plus group) sequential drops (at time 0, 20 minutes and 28 minutes) of PI 5% into the inferior conjunctival sac of one randomly selected eye. A swab culture was obtained from the inferior conjunctival fornix 5 minutes before and 30 minutes after time 0. Central corneal thickness (CCT) was measured shortly before time 0 and shortly after time 30. Conjunctival swabs were incubated aerobically in enriched Thioglycolate liquid medium (meat broth) and in three solid culture media (chocolate agar, trypticase soy agar with 5% sheep blood, and Sabouraud agar). RESULTS There was no significant difference in the proportion of negative cultures after intervention between groups (p = 0.1638). Also in the PI group (n = 59), the proportion of eyes with negative cultures after PI (79.7%) did not differ significantly from baseline (76.3%; p = 0.7539). However in the PI plus group (n = 61), the proportion of eyes with all negative cultures after PI (85.3%) was significantly higher than before PI (70.5%) (p = 0.0177). There was no significant difference in mean CCT before and after the intervention in both groups. CONCLUSION Instillation of 3 sequential drops of PI was associated with a significant increase in the proportion of eyes with all negative cultures, while instillation of a single drop of PI was not associated with a significant increase in the proportion of negative cultures. Further study is warranted to determine whether the difference between the PI administration regimens is also associated with differences in the rates of postoperative ocular infections.
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Pereira JM, Leme LM, Perdoncini MRFG, Valderrama P, Março PH. Fast Discrimination of Milk Contaminated with Salmonella sp. Via Near-Infrared Spectroscopy. FOOD ANAL METHOD 2017. [DOI: 10.1007/s12161-017-1090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Grzybowski A, Brona P. Povidone–iodine antisepsis protocols should be standardized. J Cataract Refract Surg 2017; 43:993-994. [DOI: 10.1016/j.jcrs.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
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Koerner J, George M, Rosco M, Kissam E. Bactericidal concentration of povidone–iodine. J Cataract Refract Surg 2017; 43:993. [DOI: 10.1016/j.jcrs.2017.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
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