The Effectiveness of 0.6% Povidone Iodine Eye Drops in Reducing the Conjunctival Bacterial Load and Needle Contamination in Patients Undergoing Anti-VEGF Intravitreal Injection: A Prospective, Randomized Study.

Michele Reibaldi,Antonio Longo,Carlo Cagini,Mario Toro,Claudio Furino,Robert Rejdak,Francesco Bandello,Marianna Martinelli,Matteo Fallico,Patrizia Grassi,Niccolò Castellino,Tito Fiore,Clementina Elvezia Cocuzza,Rosario Musumeci,Teresio Avitabile,Vincenza Bonfiglio,Salvatore Cillino,Katarzyna Nowomiejska,Andrea Russo

doi:10.3390/jcm8071031

Abstract

The study purpose was to assess the efficacy of a preservative-free 0.6% povidone iodine eye drops as perioperative prophylactic treatment for reducing conjunctival bacterial load and the rate of needle contamination in patients undergoing intravitreal anti-vascular endothelial growth factor injection. Enrolled patients were randomized to either the study group (0.6% povidone iodine, three day-prophylactic treatment before the injection) or to the control group (placebo, three day-prophylactic treatment). Conjunctival swabs were obtained before and after the prophylactic treatment in both groups. Intravitreal injections were performed in a sterile fashion. The injection needle and a control needle were collected for microbiological culture. Data from 254 and 253 eyes in the study group and control group, respectively, were analyzed. Bacterial growth from conjunctival swab cultures was significantly lower after 0.6% povidone iodine prophylaxis compared to baseline and to placebo prophylaxis (p < 0.001), showing an 82% eradication rate in the study group. No injection needle showed bacterial contamination in the study group, whereas six needles were culture-positive in the control group (p = 0.015). No serious ocular and non-ocular adverse events were recorded. The 0.6% povidone iodine solution proved an effective treatment in reducing conjunctival bacterial load and risk of needle contamination.

Highlights

IntroductionAntisepsis with topical povidone iodine (PI) has been shown to be the only effective prophylactic method against endophthalmitis [1,2], with the 5% solution preferred over the 10% according to both the European Society of Cataract and Refractive Surgeons (ESCRS) [3] and the American Academy of Ophthalmology (AAO) [4]
Endophthalmitis represents the most devastating among ocular complications following intravitreal injection, often leading to blindness.Antisepsis with topical povidone iodine (PI) has been shown to be the only effective prophylactic method against endophthalmitis [1,2], with the 5% solution preferred over the 10% according to both the European Society of Cataract and Refractive Surgeons (ESCRS) [3] and the American Academy of Ophthalmology (AAO) [4]
The present randomized clinical trial proved the efficacy of pre-injection treatment with 0.6% povidone iodine eye drops in reducing the proportion of specimens positive for bacterial growth both from conjunctival swabs and post-injection needles, compared to a control group

Summary

Introduction

Antisepsis with topical povidone iodine (PI) has been shown to be the only effective prophylactic method against endophthalmitis [1,2], with the 5% solution preferred over the 10% according to both the European Society of Cataract and Refractive Surgeons (ESCRS) [3] and the American Academy of Ophthalmology (AAO) [4]. Povidone iodine antisepsis does not reduce to nil the risk of endophthalmitis after intravitreal therapy, since its incidence after PI application ranges from to 0.02% to 0.3% [6] and a cumulative rate throughout the treatment series was reported in up to 1% of patients [7]. Needles used for intravitreal injections, after povidone iodine antisepsis, have been found to be contaminated by bacteria, with a range varying from 0.4% to 21% [11,12,13,14] Studies on conjunctival swab after PI antisepsis showed a significant reduction of bacterial load on the eye surface, but not a complete eradication, with a lowest rate of culture-positive swabs of 3% [8,9,10,11].

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