Topical Povidone Iodine 2.5% Versus 5% for Endophthalmitis Prophylaxis During Intravitreal Injections

Area of Science:

• Ophthalmology
• Infectious Disease Prevention
• Surgical Site Infection Control

Background:

• Topical povidone iodine (PI) is used to prevent endophthalmitis after intravitreal injections (IVIs).
• Higher concentrations of PI (5%) can cause ocular irritation.
• Lower concentrations (2.5% PI) are being explored to reduce discomfort.

Purpose of the Study:

• To compare the efficacy of 2.5% topical PI versus 5% topical PI in preventing post-intravitreal injection endophthalmitis.
• To evaluate the effectiveness of a reduced PI concentration for ocular surface disinfection prior to IVIs.

Main Methods:

• Retrospective chart review of patients undergoing IVIs between August 2017 and June 2022.
• Analysis of endophthalmitis rates in patients receiving IVIs prepared with either 2.5% PI or 5% PI.
• Standardized application protocols for both PI concentrations were followed.

Main Results:

• A total of 7360 IVIs were analyzed (3826 with 2.5% PI, 3534 with 5% PI).
• No cases of endophthalmitis occurred in the 2.5% PI group.
• Three cases (0.08%) of endophthalmitis were identified in the 5% PI group.

Conclusions:

• Both 2.5% and 5% topical PI demonstrated similar efficacy in preventing post-IVI endophthalmitis.
• The study supports the antiseptic effect of 2.5% PI for IVI procedures.
• Further prospective studies are warranted to confirm efficacy and assess ocular surface irritation.