Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

Nguyen, Chu Luan; Oh, Lawrence; Wong, Eugene; Francis, Ian C.

doi:10.5301/ejo.5000964

Cited by 14 publications

(7 citation statements)

References 24 publications

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“…Therefore, the first 2 weeks (incubation -preclinical phase) can be an important window to avoid the progression towards the phases of respiratory distress: it is therefore mandatory to avoid social contact with known people at risk, and to enter quarantine in case of contact with positive people, carefully following the rules. Suggested low level auto prophylaxis (warm domestic aerosol, alcohol/pi gargles, eye drops in case of conjunctivitis [32,51,52]) should be started as early as possible as it is free from the risk of side effects, leaving the prescription of a second level active therapy to the physician and social doctors.…”

Section: Consequences Of the Hypothesis And Discussionmentioning

confidence: 99%

A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

et al. 2020

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The new zoonotic coronavirus (SARS-CoV-2) responsible for coronavirus disease (COVID-19) is a new strain of coronavirus not previously seen in humans and which appears to come from bat species. It originated in Wuhan, Hubei Province, China, and spread rapidly throughout the world, causing over 5,569,679 global cases and 351,866 deaths in almost every country in the world, including Europe, particularly Italy. In general, based on existing data published to date, 80.9% of patients infected with the virus develop mild infection; 13.8% severe pneumonia; 4.7% respiratory failure, septic shock or multi-organ failure; 3% of these cases are fatal. Critical patients have been shown to develop acute respiratory distress syndrome (ARDS) and hospitalization in intensive care units. The average age of patients admitted to hospital is 57-79 years, with one third half with an underlying disease. Asymptomatic infections have also been described, but their frequency is not known. SARS-CoV-2 transmission is mainly airborne from one person to another via droplets. The data available so far seem to indicate that SARS-CoV-2 is capable of producing an excessive immune reaction in the host. The virus attacks type II pneumocytes in the lower bronchi through the binding of the Spike protein (S protein) to viral receptors, of which the angiotensin 2 conversion enzyme (ACE2) receptor is the most important. ACE2 receptor is widely expressed in numerous tissues, including the oropharynx and conjunctiva, but mostly distributed in ciliated bronchial epithelial cells and type II pneumocytes in the lower bronchi. The arrival of SARS-CoV-2 in the lungs causes severe primary interstitial viral pneumonia that can lead to the "cytokine storm syndrome", a deadly uncontrolled systemic inflammatory response triggered by the activation of interleukin 6 (IL-6), whose effect is extensive lung tissue damage and disseminated intravascular coagulation (DIC), that are life-threatening for patients with COVID-19. In the absence of a therapy of proven efficacy, current management consists of off-label or compassionate use therapies based on antivirals, antiparasitic agents in both oral and parenteral formulation, anti-inflammatory drugs, oxygen therapy and heparin support and convalescent plasma. Like most respiratory viruses can function and replicate at low temperatures (i.e. 34-35°C) and assuming viral thermolability of SARS-CoV-2, local instillation or aerosol of antiviral (i.e. remdesivir) in humid heat vaporization (40°-41°C) in the first phase of infection (phenotype I, before admission), both in asymptomatic but nasopharyngeal swab positive patients, together with antiseptic-antiviral oral gargles and povidone-iodine eye drops for conjunctiva (0,8-5% conjunctival congestion), would attack the virus directly through the receptors to which it binds, significantly decreasing viral replication, risk of evolution to phenotypes IV and V, reducing hospitalization and therefore death.

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Section: Consequences Of the Hypothesis And Discussionmentioning

confidence: 99%

A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

et al. 2020

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“…We read with interest the article by Nguyen et al (1) reporting that povidone-iodine 3-minute exposure time is viable in preparation for cataract surgery.…”

Section: Comments To: Povidone-iodine 3-minute Exposure Time Is Viablmentioning

confidence: 99%

Comments to: Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

Shimada

Nakashizuka

Grzybowski

2017

European Journal of Ophthalmology

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CORRESPONDENCE effect. However, povidone-iodine is an acidic solution (pH 4.5). Application of a 10% solution on the ocular surface would cause considerable pain to the patient. Iodine oxidizes water to release ions that directly act on bacterial or viral membrane proteins to effect killing. Since iodine also acts directly on membrane proteins of normal cells, using an effective and nontoxic concentration for an appropriate exposure time is important. Many basic studies on the safety of povidone-iodine have been conducted. Tissue toxicity of povidone-iodine depends on the concentration. Studies have examined the oculotoxicity of povidone-iodine to corneal epithelium, endothelial cells, and retina in rabbit eyes (Fig. 1). From the above findings, the concentration range of 0.05% to 0.5% exhibits potent antimicrobial effect and at the same time no toxicity to ocular tissues (4). We use 0.25% povidone-iodine, median value of 0.05%-0.5%, to wash ocular surface repeatedly during ophthalmic surgeries (5). Disclosures Financial support: No financial support was received for this submission.

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“…1 The authors state that randomization and masking were not possible due to the expected discomfort and discoloration effects associated with Betadine application. However, other groups have found ophthalmic PVP-I is tolerated with minimal discomfort, 3, 4 and ocular staining could be minimized by employing post-treatment irrigation. Therefore, these reasons are not necessarily valid a priori assumptions.…”

mentioning

confidence: 98%

“…Previous large-scale studies have reported that ophthalmic PVP-I has good patient tolerability and an excellent safety profile. 2–4 It has been widely utilized in clinics around the globe for decades to disinfect the eye prior to surgery 5 and intravitreal injections, 6 and more recently by some eye-care practitioners for the treatment of adenoviral conjunctivitis. 7 While the results of Ridder and colleagues 1 indicate that PVP-I alters vision and damages the corneal epithelium to a greater extent than previously recognized, we would like to point out a couple of potential limitations in their study design.…”

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confidence: 99%

Letter to the Editor: Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort

et al. 2017

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Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

Abstract: Implementation of a preoperative prophylaxis protocol that used PI 10% with a 3-minute exposure time can be performed in clinical practice. The 3-minute exposure time had no adverse sequelae.

Cited by 14 publications

References 24 publications

A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

A new pharmacological approach based on remdesivir aerosolized administration on SARS-CoV-2 pulmonary inflammation: A possible and rational therapeutic application

Comments to: Povidone-Iodine 3-Minute Exposure Time is Viable in Preparation for Cataract Surgery

Letter to the Editor: Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort

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