Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery

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. 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.

Automated summary

Endophthalmitis following intraocular surgery is rare with current antiseptic techniques, but challenges such as increased multidrug-resistant bacterial endophthalmitis and low rate of endophthalmitis caused by typical bacteria still exist. Recent findings show that povidone-iodine is widely available and repetitively applying diluted povidone-iodine can effectively sterilize the ocular surface.