Research development of povidone-iodine in clinical applications of ophthalmology_West China Medical Journal

Authors：

YIN Wen ¹ , WANG Song ¹ , LU Xiangheng ¹ , XIAO Xiao ² , ZHANG Wenqiu ¹ ,  LIU Chunling ¹

1. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Chunling, Email: liuchunling@wchscu.cn

Keywords：

Povidone-iodine; disinfection; conjunctivitis; endophthalmitis; cataract surgery

DOI：

10.7507/1002-0179.202507016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Povidone-iodine, an indispensable broad-spectrum and low-resistance antimicrobial agent in ophthalmology, holds dual therapeutic value: it serves as a preoperative conjunctival sac disinfectant to effectively prevent postoperative endophthalmitis, and as adjuvant therapy for refractory infectious eye diseases that respond poorly to conventional treatments. This article systematically summarizes the progress of clinical research on povidone-iodine, focusing on in-depth discussions of core issues such as the mechanism by which it achieves sterilization through free iodine, the controversy over concentration and exposure time in practical applications, and ocular surface safety. The aim is to provide a solid scientific basis for the standardized clinical application and future research of povidone-iodine.

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1. Zamora JL. Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions. Am J Surg, 1986, 151(3): 400-406.
2. Lepelletier D, Maillard JY, Pozzetto B, et al. Povidone iodine: properties, mechanisms of action, and role in infection control and Staphylococcus aureus decolonization. Antimicrob Agents Chemother, 2020, 64(9): 00682-20.
3. Singh S, Sawant OB, Mian SI, et al. Povidone-iodine attenuates viral replication in ocular cells: implications for ocular transmission of RNA viruses. Biomolecules, 2021, 11(5): 753.
4. Lachapelle JM, Castel O, Casado AF, et al. Antiseptics in the era of bacterial resistance: a focus on povidone iodine. Clin Pract, 2013, 10(5): 579.
5. Bigliardi PL, Alsagoff SAL, El-Kafrawi HY, et al. Povidone iodine in wound healing: a review of current concepts and practices. Int J Surg, 2017, 44: 260-268.
6. Ciulla TA, Starr MB, Masket S. Bacterial endophthalmitis prophylaxis for cataract surgery: an evidence-based update. Ophthalmology, 2002, 109(1): 13-24.
7. Jaissle GB, Szurman P, Bartz-Schmidt KU, et al. Recommendation for the implementation of intravitreal injections--statement of the German Retina Society, the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA). Klin Monbl Augenheilkd, 2005, 222(5), 390-395.
8. Grzybowski A, Kanclerz P, Myers WG. The use of povidone-iodine in ophthalmology. Curr Opin Ophthalmol, 2018, 29(1): 19-32.
9. Speaker MG, Milch FA, Shah MK, et al. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology, 1991, 98(5): 639-649.
10. Friedman DA, Mason JO 3rd, Emond T, et al. Povidone-iodine contact time and lid speculum use during intravitreal injection. Retina, 2013, 33(5): 975-981.
11. Merani R, Hunyor AP. Endophthalmitis following intravitreal anti-vascular endothelial growth factor (VEGF) injection: a comprehensive review. Int J Retina Vitreous, 2015, 1(1): 9.
12. Doshi RR, Leng T, Fung AE. Reducing oral flora contamination of intravitreal injections with face mask or silence. Retina, 2012, 32(3): 473-476.
13. 中华医学会眼科学分会眼底病学组, 中华医学会眼科学分会白内障及屈光手术学组中华医学会眼科学分会眼外伤学组, 中华医学会眼科学分会青光眼学组. 中国眼科手术后感染性眼内炎诊疗专家共识 (2022 年). 中华眼科杂志, 2022, 58(7): 487-499.
14. Borgia A, Mazzuca D, Della Corte M, et al. Prophylaxis of ocular infection in the setting of intraocular surgery: implications for clinical practice and risk management. Ophthalmol Ther, 2023, 12(2): 735.
15. Ratnumnoi R, Keorochana N, Sontisombat C. Normal flora of conjunctiva and lid margin, as well as its antibiotic sensitivity, in patients undergoing cataract surgery at Phramongkutklao Hospital. Clin Ophthalmol, 2017, 11: 237-241.
16. Gnanasekaran S, Rogers S, Wickremasinghe S, et al. The effect of diluting povidone-iodine on bacterial growth associated with speech. BMC Ophthalmol, 2019, 19(1): 62.
17. Miller KM, Oetting TA, Tweeten JP, et al. Cataract in the adult eye preferred practice pattern. Ophthalmology, 2022, 129(1): P1-P126.
18. 中华医学会眼科学分会白内障及屈光手术学组. 中国成人白内障摘除手术指南 (2023 年). 中华眼科杂志, 2023, 59(12): 977-987.
19. Koerner JC, George MJ, Meyer DR, et al. Povidone-iodine concentration and dosing in cataract surgery. Surv Ophthalmol, 2018, 63(6): 862-868.
20. Li B, Nentwich MM, Hoffmann LE, 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 Cataract Refract Surg, 2013, 39(7): 994-1001.
21. Teren D, Neuman G, Abulafia A, et al. 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(7): 682-687.
22. 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. Am J Ophthalmol, 2011, 151(1): 11-17.
23. Ta CN, Singh K, Egbert PR, et al. Prospective comparative evaluation of povidone-iodine (10% for 5 minutes versus 5% for1 minute) as prophylaxis for ophthalmic surgery. J Cataract Refract Surg, 2008, 34(1): 171-172.
24. 张硕基. 白内障术前 5%聚维酮碘对结膜囊抑菌作用和角膜上皮影响的研究. 重庆: 中国人民解放军陆军军医大学, 2019.
25. Ferguson AW, Scott JA, 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. Br J Ophthalmol, 2003, 87(2): 163-167.
26. Tofighi N, Gohari M, Sadeh M, et al. Effects of chloramphenicol, povidone-iodine 1% and 5% eye drops on the colonisation of conjunctival flora in patients undergoing cataract surgery. Ghana Med J, 2023, 57(2): 79-86.
27. Peden MC, Hammer ME, Suñer IJ. Dilute povidone-iodine prophylaxis maintains safety while improving patient comfort after intravitreal injections. Retina, 2019, 39(11): 2219-2224.
28. Patel SN, Gangaputra S, Sternberg P Jr, et al. Prophylaxis measures for postinjection endophthalmitis. Surv Ophthalmol, 2020, 65(4): 408-420.
29. Panahibazaz M, Moosavian M, Khataminia G, et al. Sub-conjunctival injection of antibiotics vs. povidone-iodine drop on bacterial colonies in phacoemulsification cataract surgery. Jundishapur J Microbiol, 2014, 7(9): e13108.
30. Shimada H, Nakashizuka H, Hattori T, et al. Prophylaxis for acute scleral buckle infection using 0. 25% povidone-iodine ocular surface irrigation during surgery. Int Ophthalmol, 2014, 34(2): 211-216.
31. Sawant OB, How S, Hurlbert S, et al. Effect of increasing povidone-iodine exposure on corneal epithelium and impact on donor rim cultures. Cornea, 2022, 41(12): 1553-1558.
32. Lindquist TD, Maxwell AJ, Miller TD, et al. Preparation of corneal donor eyes comparing 1% versus 5% povidone-iodine. Cornea, 2011, 30(3): 333-337.
33. Azzaro C, Meduri A, Oliverio G W, et al. The use of venous catheter and irrigation with povidone-iodine 0. 6% in patients with punctal and proximal canalicular stenosis: preliminary report. J Clin Med, 2024, 13(5): 1330.
34. 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). 中华眼科杂志, 2017, 53(11): 810-813.
35. Barry P, Cordovés L, Gardner S. ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery: data, dilemmas and conclusions. European Society of Cataract and Refractive Surgeons, 2013: 1-44.
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