The Effect of Povidone Iodine on the Corneal Endothelium

Abstract

Povidone iodine in both 5% and 10% concentrations demonstrates severe toxicity when one drop of either concentration is placed directly in the anterior chamber. When povidone iodine is used in preparing the eye for intraocular surgery and as an alternative to postoperative antibiotics, the inadvertent leakage of povidone iodine into the anterior chamber must definitely be prevented.

A prospective study demonstrating the effect of 5% povidone-iodine application for anterior segment intraocular surgery in Paraguay

“…No adverse reactions related to allergies or defects in the surface of the eye have been reported. Endothelial damage due to povidone-iodine has been described in experiments with rabbits (14) ; however, neither this study nor any others (15) have reported any case of the solution coming into contact with the corneal endothelium of a patient. On the other hand, because there were still a considerable number of positive cultures (12.9%) from postsurgery patients in spite of the use of povidone-iodine, it is obvious that methods should be sought to further reduce conjunctival flora.…”

Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis

“…However, this practice is by no means universal; a recent survey of ophthalmologists in Yemen 54 revealed that fewer than 6% routinely used povidone-iodine preoperatively despite its generally accepted effectiveness. [55][56][57][58][59] A recent prospective study demonstrated that topical moxifloxacin 0.5% had no significant additive effect on the preoperative reduction of conjunctival bacterial colonization beyond the effect of povidone-iodine 5% alone. 60 A 5% concentration of povidone-iodine is more effective than 1% in decreasing the human conjunctival bacterial flora in vivo.…”

Prospective study to determine the penetration of iodide into the anterior chamber following preoperative application of topical 1.25% povidone-iodine

“…In our study, the concentration of povidone-iodine in the AC was found to be much lower than this (0.001%) so that, based on our study, no cytotoxic reaction should be expected. One drop of 5 or 10% povidone iodine, when placed directly into the AC, demonstrates severe toxicity; however, no toxicity is found when the drop is placed onto the epithelial side of the cornea [1], a finding explained by the strong barrier presented by the cornea.…”

“…As for ocular tolerance, there is evidence that as high a concentration as 10% povidoneiodine solution (with no detergent) is associated with only slight cytotoxicity to the surface epithelia [21]. On the other hand, considerable side effects, such as corneal edema resulting from severe toxic alterations of the corneal endothelium, are to be expected when a 5% povidoneiodine solution penetrates the anterior chamber (AC) [1]. Hence, inadvertent leakage of povidone-iodine into the AC must be avoided at all costs in intraocular surgery.…”