Povidone-iodine concentration and dosing in cataract surgery

Survey of Ophthalmology
Jagger C KoernerMatthew M Habib

Abstract

Iodine has been recognized as an effective bactericide since the 1800s, and povidone-iodine (PI) solution has been applied to the ocular surface and periocular skin since the 1980s to prevent endophthalmitis in cataract surgery. In vitro, PI solution kills bacteria quickly at dilute concentrations (0.05%-1.0%). In many instances, PI kills bacteria more quickly at these dilute concentrations than more conventional (5%-10%) concentrations. This is due to greater availability of diatomic free iodine in dilute solution, the bactericidal component of PI. The toxicity of PI, both in vitro and clinically, has been shown to be related to concentration. Current American Academy of Ophthalmology and the European Society of Cataract and Refractive Surgeons recommendations regarding PI use suggest using 5% PI before surgery. An alternative dosing strategy uses dilute PI repetitively throughout cataract surgery (0.25% every 30 seconds). We review the povidone-iodine literature with attention to basic science and use of dilute PI.

Citations

Feb 12, 2019·Cutaneous and Ocular Toxicology·Jesse S PelletierJoseph A Capriotti
Jun 5, 2020·Clinical & Experimental Optometry : Journal of the Australian Optometrical Association·Sachin S ThakurIlva D Rupenthal
Nov 5, 2020·European Journal of Ophthalmology·Siddharth Madan, Sarita Beri
Jun 17, 2020·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Melissa ShiveJason K Rivers
Dec 29, 2020·Journal of Ocular Pharmacology and Therapeutics : the Official Journal of the Association for Ocular Pharmacology and Therapeutics·Giovanni William OliverioPasquale Aragona
Dec 29, 2020·Review Journal of Chemistry·D N MakhayevaV V Khutoryanskiy
Jan 28, 2021·BMJ Open Ophthalmology·Tommaso RossiGuido Ripandelli
Feb 18, 2021·Eye·Piotr Kanclerz, William G Myers
Aug 28, 2021·Journal of Clinical Medicine·Hiroyuki Shimada, Hiroyuki Nakashizuka
May 12, 2021·Journal of Cataract and Refractive Surgery·Leopoldo SpadeaUNKNOWN ELOOM Study Investigators
Nov 2, 2021·Current Opinion in Ophthalmology·Andrzej GrzybowskiJagger Koerner

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