Corneal Ulcer Treated with 0.66% Nanoemulsion Povidone-Iodine: A Case Report

Abstract

Unusual clinical course Background: Corneal ulceration is caused by various corneal diseases, including infection, inflammatory disease, neurotrophic keratitis, dry-eye, autoimmune disease, and blepharitis. Treatment should be based on the etiology. In cases of infection, corneal scraping and pathogen culture should be carried out before treatment. Bacterial pathogens are the most common etiology, but it can be caused also by viruses, fungi, and protozoa. Quinolones are the first-line drug for bacterial keratitis, but the treatment should be changed according to the culture and drug sensitivity test results. The purpose of this case report is to show the resolution of a corneal ulcer case unusually treated with 0.66% povidone-iodine (PVP-I). Case Report: A 61-year-old man showed signs of pain, redness, watering, and photophobia in the left eye (oculus sinister; OS) over a 5-month period, starting as conjunctivitis and degenerating into keratitis. Clinical examination revealed an ulcer in the inferior cornea and biomicroscopy analysis confirmed this diagnosis. Previous therapies, starting with antibiotics first and then antiviral medications, were unable to control the signs and symptoms. Therefore, treatment with 0.66% PVP-I, based on its antiseptic activity, was administered 3 times a day for 4 weeks. Conclusions: PVP-I 0.66%, an antiseptic with broad-spectrum activity against bacteria, fungi, viruses, and protozoa, was found to be effective in treating the signs and symptoms of the ulcer until its complete closure and resolution. It could be a useful therapeutic tool when the pathogen is unknown, as in this case. Its use for treatment of corneal ulcers warrants further investigation.

The Role of Topical Povidone-Iodine in the Management of Infectious Keratitis: A Pilot Study

“…Despite the recent increased interest in low dosage Povidone-Iodine as a broad spectrum, low-cost, resistant-free antimicrobic agent [28], there is still limited strong evidence of its in vivo effectiveness in cases of IK [14,15,[29][30][31], however, it suggests positive clinical outcomes. Herein, we present the first study to evaluate the role of 0.66% PVP-I during the time-to-results period of IK.…”

“…At concentrations between 5% and 10%, it is the elective infection-prophylactic agent in ocular surgery [11]. Nonetheless, new formulations at lower concentrations (i.e., 0.05-1.5%) have been shown to be even more effective in the treatment of ocular surface infections [12][13][14][15][16].…”

Povidone Iodine 0.66% to Fight <b><i>Pseudomonas aeruginosa</i></b> in Contact Lens Wearer: A Case Report

“…Among the different antimicrobial agents, formulations containing PVP-I have been used for antisepsis for a long time. Particularly, 0.66% PVP-I has been described in cases of corneal ulcers [44, 45] as well as in adenoviral keratoconjunctivitis [46] treated successfully. It also has several advantages when compared to other antiseptics: it has the broadest spectrum of activity, it is effective in killing ESKAPE pathogens and biofilms, and there has been no resistance or cross-resistance described even if it has been widely used for decades [18].…”

Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study

“…Moreover, two recent case reports demonstrated the effectiveness of 0.66% PVI in the resolution of signs and symptoms of a corneal ulcer, following treatment failure based on antibiotics [29,30].…”