In Praise of Povidone-Iodine Application in Ophthalmology Publisher Pubmed

Summary: Eye drops with risks? A review suggests povidone-iodine (PVP-I) effectively prevents and treats infections like conjunctivitis, but watch for irritation—valuable in resource-limited settings. #Ophthalmology #Antiseptics

Soleimani M^{1, 2} ; Haydar AA¹ ; Cheraqpour K¹ ; Zeidabadinejad H¹ ; Esfandiari A¹ ; Eshaghhosseiny N³ ; Shahmohammadi A⁴ ; Banz S^{2, 5} ; Djalilian AR²
Source: Survey of Ophthalmology Published:2024

Abstract

Polyvinyl pyrrolidone or povidone-iodine (PVP-I) is a water-soluble complex formed by the combination of iodine and a water-soluble polymer, polyvinyl pyrrolidone. This complex exerts bactericidal, fungicidal, and virucidal action by gradually releasing free iodine at the site of application to react with pathogens. In ophthalmology, PVP-I is used as a disinfectant and antiseptic agent for preoperative preparation of the skin and mucous membranes and for treating contaminated wounds. PVP-I has been shown to reduce effectively the risk of endophthalmitis in various ocular procedures, including cataract surgery and intravitreal injections; however, it has also been used in the treatment of conjunctivitis, keratitis, and endophthalmitis, with promising results especially in low-resource situations. PVP-I has been associated with complications such as postoperative eye pain, persistent corneal epithelial defects, ocular inflammation, and an attendant risk of keratitis. In cases of poor PVP-I tolerance, applying PVP-I at lower concentrations or using alternative antiseptics such as chlorhexidine should be considered. We provide an update on the efficacy of PVP-I in the prophylaxis and treatment of conjunctivitis, keratitis, and endophthalmitis and a comprehensive analysis of the current literature regarding the use of PVP-I in the management of these ocular conditions. Also, PVP-I-related adverse effects and toxicities and its alternatives are discussed. The goal is to present a thorough evaluation of the available evidence and to offer practical recommendations for clinicians regarding the therapeutic usage of PVP-I in ophthalmology. © 2024 Elsevier Inc.