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中华眼科医学杂志(电子版) ›› 2024, Vol. 14 ›› Issue (02) : 65 -70. doi: 10.3877/cma.j.issn.2095-2007.2024.02.001

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重视聚维酮碘在白内障手术中的应用与研究
赵天瑶1, 孙英娟2, 江晓丹3, 李学民3,†()   
  1. 1. 100191　北京大学第三医院眼科中心2021级博士研究生
    2. 102400　北京中医药大学房山医院眼科
    3. 100191　北京大学第三医院眼科中心　眼部神经损伤的重建保护与康复北京市重点实验室
  • 收稿日期:2024-04-03 出版日期:2024-04-28
  • 通信作者: 李学民
  • 基金资助:
    首都卫生发展科研专项项目(首发2024－2－40913)

Pay attention to the application and research of povidone iodine in cataract surgery

Tianyao Zhao1, Yingjuan Sun2, Xiaodan Jiang3, Xuemin Li3,†()   

  1. 1. Doctoral degree 2021, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
    2. Fangshan Hospital Beijing University of Chinese Medicine, Beijing 102400, China
    3. Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing 100191, China
  • Received:2024-04-03 Published:2024-04-28
  • Corresponding author: Xuemin Li
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引用本文：

赵天瑶, 孙英娟, 江晓丹, 李学民. 重视聚维酮碘在白内障手术中的应用与研究[J]. 中华眼科医学杂志(电子版), 2024, 14(02): 65-70.

Tianyao Zhao, Yingjuan Sun, Xiaodan Jiang, Xuemin Li. Pay attention to the application and research of povidone iodine in cataract surgery[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(02): 65-70.

聚维酮碘(PVI)作为白内障术前消毒的常规选择，因其高效广谱的抗菌特性而广泛应用于眼科手术中。PVI通过氧化作用和直接损伤微生物细胞结构发挥抗菌效果，对多种细菌、真菌及病毒具有杀灭作用，但PVI在眼内具有潜在毒性，需要关注其药物浓度、时间选择及患者耐受性等问题。既往的研究结果表明，适当浓度和作用时间的PVI对角膜上皮和角膜内皮细胞损伤较小，但高浓度PVI可能对眼部组织产生不良影响。此外，PVI在前房内的药代动力学特性对于评估其预防术后眼内炎效果至关重要，但相关机制尚不完全明确。未来的研究将聚焦于优化PVI的使用浓度和剂量、开发新配方、探索替代或联合使用的抗菌剂，并更新临床实践指南以提升PVI使用的安全性和有效性。本文中笔者对PVI的抗菌特性、在白内障术前消毒中的应用规范、不同浓度PVI的应用效果、潜在毒性及未来研究的方向进行评述。

关键词: 聚维酮碘, 白内障手术, 术前消毒, 药代动力学, 眼部毒性

Povidone-iodine(PVI), as a conventional choice for preoperative disinfection in cataract surgery, has been extensively utilized in ophthalmic procedures due to its efficient and broad-spectrum antimicrobial properties. PVI exerts antibacterial effects through oxidation and direct damage to microbial cell structures, and has a killing effect on various bacteria, fungi, and viruses. However, PVI has a potential toxicity for the eyes. Its drug concentration, time selection, and patient tolerance should be paid attention. It has shown that PVI with appropriate concentration and duration of action causes less damage to corneal epithelium and endothelial cells, but high concentrations of PVI may have adverse effects on ocular tissues. Moreover, the pharmacokinetic characteristics of PVI within the anterior chamber are crucial for evaluating its effectiveness in preventing postoperative endophthalmitis, yet the relevant mechanisms are not fully understood. Future research will focus on optimizing the concentration and dosage of PVI, developing new formulations, exploring alternative or combination antimicrobial agents, and updating clinical practice guidelines to enhance the safety and efficacy of PVI use. The antibacterial properties of PVI, the application standards in preoperative disinfection of cataracts, the application effects of different concentrations of PVI, potential toxicity, and future research directions were reviewed in this paper.

Key words: Povidone-iodine, Cataract surgery, Preoperative disinfection, Pharmacokinetics, Ocular toxicity
表1 聚维酮碘浓度≥1.0%对白内障手术消毒效果评价的文献汇总
第一作者 发表年份 研究设计 PVI浓度 其它药物 PVI作用时间 样本量 评价指标 主要发现
Ferguson[9] 2003 前瞻性随机双盲研究 5.0%、1.0%   1 min 105 细菌菌落形成单位数 5.0%PVI在减少人类结膜细菌数量方面比1.0%更有效
Li[23] 2013 随机临床实验 10.0%、5.0%及1.0%     271 结膜囊细菌培养阳性率 10.0%PVI在减少术前结膜细菌负荷方面比1.0%和5.0%更有效
Carrim[24] 2009 前瞻性对照研究 5.0%   3 min 54 结膜囊细菌培养阳性率，平均物种数 5.0%PVI冲洗3 min能显著减少如凝固酶阴性葡萄球菌等微生物的数量
Sreedhar[25] 2024 前瞻性研究 5.0%PVI、5.0%PVI＋0.5%莫西沙星 0.5%莫西沙星   192 结膜囊细菌培养阳性率 5.0%PVI单独作为术前预防与0.5%莫西沙星联合使用同样有效
Fan[26] 2020 前瞻性研究 5.0%PVI＋0.5%左氧氟沙星 0.5%左氧氟沙星 3 min 31 结膜囊菌群的多样性和丰富度 5.0%PVI在减少结膜菌群的多样性和丰富度方面效果显著，但无法完全无菌
张硕基[27] 2019 前瞻性随机对照研究 5.0%   30 s、1 min、2 min及3.5 min 400 结膜囊细菌培养阳性率 5.0%PVI冲洗2 min和3.5 min能更有效减少术前结膜囊细菌负荷
表2 聚维酮碘浓度<1.0%对白内障手术消毒效果评价的文献汇总
第一作者 发表年份 研究设计 PVI浓度 PVI作用时间 样本量 评价指标 主要发现
Shimada[30] 2011 前瞻性对照研究 0.25% 术中每20～30 s冲洗 404 前房细菌污染率 0.25%PVI冲洗能显著降低前房细菌污染率
Musumeci[31] 2021 多中心非随机、前瞻性对照研究 0.66% 术前3 d，3次/d 120 结膜囊细菌培养阳性率 0.66%PVI滴眼液在术前使用可有效减少结膜细菌载量，可能成为术前抗感染预防的有效辅助手段
樊芳[32] 2019 前瞻性研究 5 g/L、1 g/L及0.5 g/L 冲洗30 s、1 min及2 min 270 结膜囊细菌培养阳性率 0.5 g/L的PVI冲洗30 s能有效减少结膜囊细菌且对眼表损伤更小
封艳[34] 2019 随机对照研究 0.025%和0.05% 术前、开睑后冲洗2次 600 结膜囊细菌培养阳性率 0.025%PVI与0.05%PVI消毒效果无差异，但对改善患者舒适度方面存在优势
Fan[35] 2019 随机对照研究 0.05% 30 s、1 min及2 min 90 结膜囊细菌培养阳性率 0.05%PVI冲洗30 s可降低细菌污染率，减少眼表损伤
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