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

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.

<p>Anterior Acute Uveitis Report in a SARS-CoV-2 Patient Managed with Adjunctive Topical Antiseptic Prophylaxis Preventing 2019-nCoV Spread Through the Ocular Surface Route</p>

“…In recognition of the common phylogenetic and structural characteristics of SARS-CoV-2 with SARS-CoV-1, 13 and the proved efficacy of PVP-I in reducing viral activity of SARS-COV-1, 18 we introduced the use of 0.6% PVP-I eye drops recently tested for ophthalmic use. 17 Povidoneiodine (PVP-I) products have been extensively used for the disinfection of various bacteria and viruses for years because of their strong bactericidal and antiviral activities. 17,18 The free-iodine released from the PVP-I complex performs its biocidal activity by acting directly on the external membranes of microorganisms, oxidizing their proteins and leading to the death of pathogens.…”

“…17 Povidoneiodine (PVP-I) products have been extensively used for the disinfection of various bacteria and viruses for years because of their strong bactericidal and antiviral activities. 17,18 The free-iodine released from the PVP-I complex performs its biocidal activity by acting directly on the external membranes of microorganisms, oxidizing their proteins and leading to the death of pathogens. The treatment of SARS-CoV-1 with PVP-I products for 2 minutes reduced virus infectivity from 1.17 x 10 6 TCID 50 /mL to below the detectable level.…”

“…The topical therapy included mydriatic eye-drops (tropicamide 10mg/mL solution, Visumidriatic®, Visufarma, Rome, Italy) 3 times daily in prevention of synechiae, reducing the ocular inflammation, and a fixed antibiotic-steroidal association 3 times daily (0.5% chloramphenicol plus 0.2% betamethasone) eyedrops (Betabioptal® suspension, Thea Pharma, Milan, Italy). Moreover, in order to expand the biocidal spectrum to viruses we decided to include in the treatment protocol some antiseptics, approved and available in the market for ophthalmic use, such as 0.02% sodium hypochlorite (HOCl) preserved solution (Septavis®, Medivis, Catania, Italy) nebulized on the periocular skin 2 times daily reducing the eyelid rhyme viral load, 15,16 0.6% PVP-I eyedrops (Iodim®, Medivis, Catania, Italy) administered 2 times daily 17,18 and antiseptic lubricants based on 10.50% ozonized oil eye-drops with liposomes (Ozodrop®, FB Vision, Ascoli Piceno, Italy) administered 3 times daily. [19][20][21][22] The clinical symptoms regressed completely in 4 weeks and at the one-month follow-up visit, as clearly documented in Figure 2, the pigmentary deposits and diffuse whitish inflammatory opacities of the anterior The laboratory data, as reported in Table 3, excluded HLA B27 positivity, Lupus Anti-Coagulant (LAC), TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex, Epstein Barr and HIV complex antibodies), Anti-Nuclear-Antigen (ANA) and Extractable-Nuclear-Antigens (ENA) associated uveitis.…”

“…9 Unfortunately, as no specific therapies are available for SARS-CoV-2 and there is not yet a vaccine or effective antiviral drug, recognizing the common characteristics between SARS-CoV-2 and SARS-CoV-1, 13 we introduced the adjunctive use of a precautionary multi-acting eye topical treatment named SHYPIO (Sodium Hypochlorite Povidone-Iodine Ozonized oil) in our clinical practice protocol, to prevent the spread of the virus through the ocular route of transmission, whose active principles and dosage are reported in Table 1. The eye prophylaxis included a 0.02% sodium hypochlorite solution for the periocular skin and eyelid rhyme, in consideration of its antiviral activity against SARS-CoV-2, 15 and available in ophthalmology for the therapy of blepharitis, 16 0.6% Povidone-Iodine (PVP-I) eye-drops 17 for patients with acute follicular conjunctivitis based on its recognized efficacy (equivalent to 70% ethanol) inactivating SARS-CoV-1, 18 according to the common structural characteristics of SARS-CoV-1 and SARS-CoV-2, 13 and 10.50% Ozonized oil eye-drops 19,20 with lubricant and ozone-mediated biocidal activity. 21,22 Antiseptics were also used in the pandemic for contact lenses wearers affected by high myopia, cases with severe keratoconus, poor visual acuity not suitable with sufficient spectacles correction, healthcare professionals and eye-care practitioners that could also be guaranteed a higher level of protection from the risk of infection through the reduction of the ocular surface viral load.…”

Exogenous Fungal Endophthalmitis: Clues to Aspergillus Aetiology with a Pharmacological Perspective

“…The rates are higher after intravitreal corticosteroids than after intravitreal anti-VEGF agents [ 26 ]. While prophylaxis with topical antibiotics has been shown to increase, rather than reduce, the risk of post-injection endophthalmitis [ 27 ], preoperative disinfection with topical 5% povidone iodine represents the most commonly used and safest method against endophthalmitis [ 28 , 29 ]. Incidence of endophthalmitis does not seem to be affected by the type of intravitreal anti-VEGF drugs [ 25 , 26 ].…”