Pars Plana Vitrectomy Using 0.025% Povidone-Iodine Irrigation for Acute Endophthalmitis: A Retrospective Case-Control...

To compare visual and anatomical outcomes of patients with acute endophthalmitis treated with pars plana vitrectomy (PPV) using either 0.025% povidone-iodine (PI) or standard balanced salt solution (BSS) irrigation and to evaluate the safety profile of intraocular PI.

Retrospective case-control study.

Ninety-two patients (48 in the PI group and 44 in the BSS group) aged ≥18 years with acute endophthalmitis of various etiologies treated between January 2017 and December 2024.

All patients underwent 23- or 25-gauge PPV and received intravitreal moxifloxacin and dexamethasone. The study group received 0.025% PI irrigation, whereas the control group received standard BSS irrigation. Main outcomes included best-corrected visual acuity (BCVA), infection resolution, reactivation, and postoperative findings potentially associated with ocular toxicity. Safety assessments were based on slit-lamp examination, retinal imaging, and optical coherence tomography.

Clinical resolution at 1 week was achieved in 68.8% of eyes in the PI group and 65.9% in the control group (p = 0.83). No statistically significant differences were observed between groups regarding infection resolution, recurrence/reactivation, or BCVA outcomes. At 3 months, mean BCVA was logMAR 1.096 (approximately 20/250) in the PI group and logMAR 1.70 (count fingers) in the control group. Fewer postoperative findings potentially associated with ocular toxicity were observed in the PI group compared with controls (20.8% vs. 70.5%; p <0.001).

In this retrospective case-control study, 0.025% PI irrigation during PPV was not associated with worse short-term anatomical or visual outcomes compared with standard BSS irrigation. Although postoperative adverse findings were less frequent in the PI group, this result should be interpreted cautiously given the non-randomized design and earlier timing of vitrectomy in the PI group. Prospective controlled studies are needed to confirm the safety and potential efficacy of this approach.