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

doi:10.3877/cma.j.issn.2095-2007.2024.02.001

Abstract

Abstract:

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

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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhykyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2007.2024.02.001

https://zhykyxzz.cma-cmc.com.cn/EN/Y2024/V14/I02/65

Figures/Tables 2

References 53

[1]	Ramachandran A, Das T, Pathengay A, et al. Surgical approach to endophthalmitis: an overview[J]. Eye (London, England), 2024, PMID: 38698052.
[2]	Lundström M, Wejde G, Stenevi U, et al. Endophthalmitis after Cataract Surgery：A Nationwide Prospective Study Evaluating Incidence in Relation to Incision Type and Location[J]. Ophthalmology Rochester & Hagerstown, 2007, 114: 866－870.
[3]	Lepelletier D, Maillard J, Pozzetto B, et al. Staphylococcus aureus Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Decolonization[J]. Antimicrobial agents and chemotherapy, 2020, 64(9): e00682.
[4]	Isenberg，Sherwin.ChemicalL et al. Chemical preparation of the eye in ophthalmic surgery. III. Effect of povidone－iodine on the conjunctiva[J]. Arch Ophthalmol, 1984, 102(5): 728－729.
[5]	Barry P, Cordoves L, Gardner S. ESCRS Guidelines for Prevention and Treatment of Endophthalmitis Following Cataract Surgery: Data, Dilemmas and Conclusions 2013[M]Dublin: Blackrock, 2013: 7－48.
[6]	Kevin M M, Thomas A O, James P T, et al. Cataract in the Adult Eye Preferred Practice Pattern[J]. Ophthalmology, 2021, 129(1)：1－126.
[7]	Ferguson A, Scott J, Mcgavigan J, et al. Comparison Of 5% Povidone－Iodine Solution Against 1% Povidone－Iodine Solution In Preoperative Cataract Surgery Antisepsis: a Prospective Randomised Double Blind Study[J]. The British Journal Of Ophthalmology, 2003, 87(2): 163－167.
[8]	Ciulla, Thomas, A．，Et Al. Bacterial Endophthalmitis Prophylaxis For Cataract Surgery[J]. Ophthalmology, 2002, 109(1): 13－24.
[9]	中华医学会眼科学分会白内障及人工晶状体学组. 我国白内障摘除手术后感染性眼内炎防治专家共识(2017年)[J]. 2017, 53(11)：810－813
[10]	Napolitano P, Filippelli M, Davinelli S, et al. Influence of gut microbiota on eye diseases: an overview[J]. Annals of medicine, 2021, 53(1): 750－761.
[11]	Rackur H. New aspects of mechanism of action of povidone－iodine[J]. The Journal of hospital infection, 1985: 13－23.
[12]	Berkelman R, Holland B, Anderson R. Increased bactericidal activity of dilute preparations of povidone－iodine solutions[J]. Journal of clinical microbiology, 1982, 15(4): 635－639.
[13]	Batioglu－Karaaltin A, Yigit O, Cakan D, et al. Effect of the povidone iodine, hypertonic alkaline solution and saline nasal lavage on nasopharyngeal viral load in COVID－19[J]. Clinical otolaryngology, 2023, 48(4): 623－629.
[14]	Lachapelle JM, Castel O, Casado AF, et al. Antiseptics in the era of bacterial resistance: A focus on povidone iodine[J]. Clinical Practice, 2013, 10(5): 579－592.
[15]	Gryson L, Meaume S, Feldkaemper I, et al. Anti－biofilm Activity of Povidone－Iodine and Polyhexamethylene Biguanide: Evidence from In Vitro Tests[J]. Current microbiology, 2023, 80(5): 161.
[16]	Konduri R, Savitri S, Sisinthy S. Microbes of the human eye: Microbiome, antimicrobial resistance and biofilm formation[J]. Exp Eye Res, 2021, 205: 108476.
[17]	Barreto R, Barrois B, Lambert J, et al. Addressing the challenges in antisepsis: focus on povidone iodine[J]. International journal of antimicrobial agents, 2020, 56(3): 106064.
[18]	Iwasaki T, Nejima R, Miyata K. Ocular surface flora and prophylactic antibiotics for cataract surgery in the age of antimicrobial resistance[J]. Japanese Journal of Ophthalmology, 2022, 66(2): 111－118.
[19]	Aragona P, Baudouin C, Benitez Del Castillo J, et al. The ocular microbiome and microbiota and their effects on ocular surface pathophysiology and disorders[J]. Survey of ophthalmology, 2021, 66(6): 907－925.
[20]	Van Den Broek P, Buys L, Van Furth R. Interaction of povidone－iodine compounds, phagocytic cells, and microorganisms[J]. Antimicrobial agents and chemotherapy, 1982, 22(4): 593－597.
[21]	Li B, Nentwich M, Hoffmann L, et al. Comparison of the efficacy of povidone－iodine 1.0%, 5.0%, and 10.0% irrigation combined with topical levofloxacin 0.3% as preoperative prophylaxis in cataract surgery[J]. Journal of cataract and refractive surgery, 2013, 39(7): 994－1001.
[22]	Carrim Z, Mackie G, Gallacher G, et al. The efficacy of 5% povidone－iodine for 3 minutes prior to cataract surgery[J]. European journal of ophthalmology, 2009, 19(4): 560－564.
[23]	Sreedhar S, Rajalakshmi A, Nagarajan S, et al. Comparison of preoperative prophylaxis with povidone－iodine (5%) and moxifloxacin (0.5%) versus povidone－iodine (5%) alone: a prospective study from India[J]. International ophthalmology, 2024, 44(1): 48.
[24]	Fan C, Yang B, Huang Y. Efficacy of 0.5% Levofloxacin and 5.0% Povidone－Iodine Eyedrops in Reducing Conjunctival Bacterial Flora: Metagenomic Analysis[J]. Journal of ophthalmology, 2020, PMID: 32377412.
[25]	张硕基，刘佩，黎敏，等. 白内障摘除手术前国产5%聚维酮碘对结膜囊抑菌作用及角膜上皮影响的初步观察[J]. 中华眼科杂志，2019，55(7)：509－514..
[26]	Inoue Y, Usui M, Ohashi Y, et al. Preoperative disinfection of the conjunctival sac with antibiotics and iodine compounds: A prospective randomized multicenter study[J]. Japanese Journal of Ophthalmology, 2008, 52(3): 151－161.
[27]	Shimada H, Nakashizuka H. Cataract Surgery by Intraoperative Surface Irrigation with 0.25% Povidone－Iodine[J]. Journal of Clinical Medicine, 2021, 10(16): 3611.
[28]	Shimada H, Arai S, Nakashizuka H, et al. Reduction of Anterior Chamber Contamination Rate After Cataract Surgery by Intraoperative Surface Irrigation With 0.25% Povidone－Iodine[J]. American Journal of Ophthalmology, 2011, 151(1): 11－17.
[29]	Musumeci R, Troiano P, Martinelli M, et al. Effectiveness of 0.66% Povidone－Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study[J]. Journal of clinical medicine, 10(10): 2198.
[30]	樊芳，赵智华，赵晓彬，等. 白内障术前应用不同浓度聚维酮碘的疗效观察[J]. 国际眼科杂志，2019，13(12)：2528－2529.
[31]	Fan F, Zhihuazhao, Xiaobinma, et al. Reduction of Ocular Surface Damage and Bacterial Survival Using 0.05% Povidone－Iodine Ocular Surface Irrigation before Cataract Surgery[J]. Ophthalmic Research: Journal for Research in Experimental and Clinical Ophthalmology, 2019, 62(3): 166－172.
[32]	封艳，潘玲，吴欲晓，等. 不同浓度聚维酮碘二次冲洗法对白内障手术结膜囊消毒效果的评价[J]. 国际眼科杂志，2019，19(8)：1403－1405.
[33]	Fan F, Zhao Z, Zhao X, et al. Reduction of Ocular Surface Damage and Bacterial Survival Using 0.05% Povidone－Iodine Ocular Surface Irrigation before Cataract Surgery[J]. Ophthalmic research, 2019, 62(3): 166－172.
[34]	Shibata Y, Tanaka Y, Tomita T, et al. Evaluation of corneal damage caused by iodine preparations using human corneal epithelial cells[J]. Japanese journal of ophthalmology, 2014, 58(6): 522－527.
[35]	Trinavarat A, Atchaneeyasakul L, Nopmaneejumruslers C, et al. Reduction of endophthalmitis rate after cataract surgery with preoperative 5% povidone－iodine[J]. Dermatology (Basel, Switzerland), 2006, 212 (Suppl 1): 35－40.
[36]	Yao K, Zhu Y, Zhu Z, et al. The incidence of postoperative endophthalmitis after cataract surgery in China: a multicenter investigation of 2006－2011[J]. The British journal of ophthalmology, 2013, 97(10): 1312－1317.
[37]	Prucha V, Egerbacher M, Tichy A, et al. Effects of diluted povidone iodine on viability and migration of canine corneal epithelial and stromal cells in tissue culture[J]. Research in veterinary science, 2022, 151: 1－9.
[38]	Ridder W, Oquindo C, Dhamdhere K, et al. Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort[J]. Optometry and vision science : official publication of the American Academy of Optometry, 2017, 94(7): 732－741.
[39]	Kim S, Ahn Y, Lee Y, et al. Toxicity of Povidone－iodine to the ocular surface of rabbits[J]. BMC ophthalmology, 2020, 20(1): 359.
[40]	吴善君，周宏健，姚红艳，等. 白内障术前应用不同浓度聚维酮碘溶液的不良反应观察[J]. 国际眼科杂志，2013，13(12)：2528－2529.
[41]	李俊，李维英，彭智培，等. 聚维酮碘对人角膜内皮细胞的影响[J]. 中华眼科杂志，2005，41(2)：169－172.
[42]	Alp BN, Elibol O, Sargon MF ，et al. The effect of povidone iodine on the corneal endothelium[J]. Cornea, 2000, 19(4): 546－550.
[43]	Lerhaupt K, Mauger T. Corneal endothelial changes from exposure to povidone iodine solution[J]. Cutaneous and ocular toxicology, 2006, 25(2): 63－65.
[44]	Naor J, Savion N, Blumenthal M, et al. Corneal endothelial cytotoxicity of diluted povidone－－iodine[J]. Journal of cataract and refractive surgery, 2001, 27(6): 941－947.
[45]	Rania SE, Weam ME, Eman KH, et al. Safety of Intracameral Injection of Minimal Bactericidal Concentration of Povidone Iodine on the Corneal Endothelium in a Rabbit Model[J]. Cornea, 2016, 35(1): 72－76.
[46]	Whitacre M, Crockett R. Tolerance of intravitreal povidone－iodine in rabbit eyes[J]. Current eye research, 1990, 9(8): 725－732.
[47]	Kim KH, Cao J, Yoo JW, et al. Intraocular Pharmacokinetics of Povidone－Iodine and Its Effects on Experimental Staphylococcus epidermidis Endophthalmitis[J]. Investigative ophthalmology & visual science, 2015, 56(11): 6694－6700.
[48]	Trost LW, Kivilcim M, Peyman GA, et al. The effect of intravitreally injected povidone－iodine on Staphylococcus epidermidis in rabbit eyes[J]. Journal of Ocular Pharmacology & Therapeutics the Official Journal of the Association for Ocular Pharmacology & Therapeutics, 2007, 23(1): 70－77.
[49]	Shimada H, Kato K, Ishida K, et al. Evaluation of Retinal Function and Pathology After Intravitreal Injection of Povidone－Iodine and Polyvinyl Alcohol－Iodine in Rabbits[J]. Translational vision science & technology, 2020, 9(5): 5.
[50]	Celso Soares Pereira B, Irene L－G, María G, et al. Comparing the in vitro efficacy of chlorhexidine and povidone－iodine in the prevention of post－surgical endophthalmitis[J]. J Ophthalmic Inflamm Infect, 2024, 14(1)：20.
[51]	Merani R, Mcpherson Z, Luckie A, et al. Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature[J]. Ophthalmology, 2016, 123(12): 2588－2594.
[52]	Jiangtao S, Wantao Y, Xiaoxia G, et al. Development and Evaluation of a Novel Antibacterial Wound Dressing: A Powder Preparation Based on Cross－Linked Pullulan with Polyhexamethylene Biguanide for Hydrogel－Transition in Advanced Wound Management and Infection Control[J]. Polymers (Basel), 2024, 16(10): 1352.
[53]	Thomas WH, Lauren AM, Layan K. Hypochlorous Acid 0.01% vs Povidone－Iodine 5% for Ocular Antisepsis[J]. J Vitreoretin Dis, 2021, 6(2): 132－137.

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

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

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

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

Please choose a citation manager

Content to export