povidone-iodine and Corneal-Ulcer

To investigate antimicrobial effectiveness of povidone-iodine (Betadine) in reducing bacterial load of corneal ulcers before patients were given antibiotics.. Patients with corneal ulcers were randomized to Betadine or placebo group. Ulcers were cultured before and after a 10-minute application of 5% Betadine or preservative-free artificial tears. All patients were then treated with standard antibiotic medications. The number of colony-forming units before and after Betadine or placebo was compared.. Eighteen patients were randomized to Betadine and 17 to placebo group. In the Betadine group, 8 (44%) of 18 ulcers were culture-positive, either before and/or after pretreatment, and in the control group, 9 (53%) of 17 were culture positive. There was No statistical difference in colony-forming units change after Betadine versus artificial tears application was detected (P-value = 0.16, t-test). In Betadine group, 3 (17%) of 18 of patients showed improvement, ie, had fewer colonies after drop application; and in the placebo group, 7 (41%) of 17 showed improvement, (P = 0.15, Fisher exact t test.). A single application of 5% Betadine did not reduce the bacterial load of corneal ulcers more than just scraping/rinsing alone. This is likely the result of the lack of penetration deep into the corneal stroma and number of organisms present. Other factors may be involved.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Bacteria; Colony Count, Microbial; Corneal Ulcer; Eye Infections, Bacterial; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Povidone-Iodine; Treatment Outcome

To assess whether povidone-iodine provided any benefit over and above a standard regimen of antibiotic therapy for the treatment of corneal ulcers.. All patients diagnosed with corneal ulcers presenting for care at a primary eye care clinic in rural Nepal were randomised to a standard protocol of antibiotic therapy versus standard therapy plus 2.5% povidone-iodine every 2 hours for 2 weeks. The main outcomes were corrected visual acuity and presence, size, and position of corneal scarring in the affected eye at 2-4 months following treatment initiation.. 358 patients were randomised and 81% were examined at follow up. The two groups were comparable before treatment. At follow up, 3.9% in the standard therapy and 6.9% in the povidone-iodine group had corrected visual acuity worse than 20/400 (relative risk (RR) 1.77, 95% confidence interval (CI) 0.62 to 5.03). 9.4% in the standard therapy and 13.1% in the povidone-iodine group had corrected visual acuity worse than 20/60 (RR 1.39, 95% CI 0.71 to 2.77), and 17.0% and 18.8% had scars in the visual axis in each of these groups, respectively (RR 1.11, 95% CI 0.67 to 1.82).. A small proportion of patients with corneal ulceration treated in this setting had poor visual outcomes. The addition of povidone-iodine to standard antibiotic therapy did not improve visual outcomes, although this design was unable to assess whether povidone-iodine on its own would have resulted in comparable visual outcomes to that of standard therapy.

Topics: Adolescent; Adult; Anti-Infective Agents, Local; Child; Corneal Ulcer; Female; Humans; Iodophors; Male; Middle Aged; Nepal; Povidone-Iodine; Treatment Outcome; Vision Disorders; Visual Acuity

We report a unique case of fungal keratitis, caused by the Cladosporium species, which is found to be resistant to multiple drugs, including voriconazole. Cladosporium belongs to the dematiaceous group of fungus, which is present ubiquitous in air, water, food etc. There are only few case reports available about Cladosporium keratitis which shows the successful management with voriconaozle. But in our case, the Cladosporium species was found to be resistant to multiple drugs, including voriconazole, and was successfully managed by topical povidone iodine (PVI) 5%.

Topics: Antifungal Agents; Cladosporium; Corneal Ulcer; Eye Infections, Fungal; Humans; Keratitis; Povidone-Iodine; Voriconazole

BACKGROUND Peripheral ulcerative keratitis is one of the ocular complications associated with chronic inflammatory immune-mediated diseases, such as rheumatoid arthritis, in which inflammatory reactions and infections can be recurrent. Suspected infections are treated with topical antibiotics that, in some cases, may promote selection of resistant microbes. Povidone iodine is known for its rapid broad-spectrum activity against all kinds of microbes and biofilms, lack of microbial resistance, ability to counteract excessive inflammation, and efficacy in wound healing, along with an optimum safety and tolerability profile. The purpose of this case report is to show the resolution of a peripheral ulcerative keratitis case by means of treatment with 0.66% povidone iodine. CASE REPORT An 89-year-old woman with rheumatoid arthritis, 1 eye, and a superior descemetic corneal ulcer was treated with amniotic membrane, topical antibiotics, and antiviral drugs without any control of clinical signs and symptoms. Therefore, all anti-infective treatments were replaced with 0.66% povidone iodine (3 times/day) given alone for 5 weeks and then associated with serum eyedrops. When a clear regression of the ulcer was observed, the patient was maintained with serum eyedrops only. CONCLUSIONS Unusual treatment with povidone iodine 0.66% (used for the first time in an autoimmune patient), alone and in association with serum eyedrops, probably contributed to alleviate the signs and symptoms of a case of peripheral ulcerative keratitis not responding to conventional treatments. Although its regular use warrants further investigation, povidone iodine seems a useful therapeutic tool for the treatment of corneal ulcers associated with chronic immune-mediated inflammatory diseases.

Topics: Aged, 80 and over; Anti-Infective Agents, Local; Arthritis, Rheumatoid; Corneal Ulcer; Female; Humans; Povidone; Povidone-Iodine

BACKGROUND Corneal ulceration is caused by various corneal diseases, including infection, inflammatory disease, neurotrophic keratitis, dry-eye, autoimmune disease, and blepharitis. Treatment should be based on the etiology. In cases of infection, corneal scraping and pathogen culture should be carried out before treatment. Bacterial pathogens are the most common etiology, but it can be caused also by viruses, fungi, and protozoa. Quinolones are the first-line drug for bacterial keratitis, but the treatment should be changed according to the culture and drug sensitivity test results. The purpose of this case report is to show the resolution of a corneal ulcer case unusually treated with 0.66% povidone-iodine (PVP-I). CASE REPORT A 61-year-old man showed signs of pain, redness, watering, and photophobia in the left eye (oculus sinister; OS) over a 5-month period, starting as conjunctivitis and degenerating into keratitis. Clinical examination revealed an ulcer in the inferior cornea and biomicroscopy analysis confirmed this diagnosis. Previous therapies, starting with antibiotics first and then antiviral medications, were unable to control the signs and symptoms. Therefore, treatment with 0.66% PVP-I, based on its antiseptic activity, was administered 3 times a day for 4 weeks. CONCLUSIONS PVP-I 0.66%, an antiseptic with broad-spectrum activity against bacteria, fungi, viruses, and protozoa, was found to be effective in treating the signs and symptoms of the ulcer until its complete closure and resolution. It could be a useful therapeutic tool when the pathogen is unknown, as in this case. Its use for treatment of corneal ulcers warrants further investigation.

Topics: Anti-Infective Agents, Local; Corneal Ulcer; Diagnosis, Differential; Humans; Male; Middle Aged; Povidone-Iodine

The concentration and dosing of povidone-iodine (PI) solution used in surgical site prophylaxis are variable. Prior in vitro work has demonstrated that dilute PI solutions (<1%) had greater bactericidal activity than stock solutions (10%). Studies using pathologic clinical isolates from the eye have yielded mixed results. The purpose of the current study was to evaluate the efficacy of different concentrations of PI on pathologic ocular surface isolates.. None of the isolates survived exposure to the PI 0.25% solution for 30 seconds.. Our results are consistent with prior in vitro studies of PI, from nonocular sources, and suggest that PI has similar bactericidal action on pathologic bacteria from the ocular surface. In vitro exposure to dilute PI (0.25%) resulted in no growth after 30 seconds, whereas 10% and 5% solutions took longer to kill several of the isolates. Future investigations of PI use in ophthalmology as an antimicrobial agent should include the study of low-concentration PI (0.25%).

Topics: Anti-Bacterial Agents; Bacteria; Corneal Ulcer; Dose-Response Relationship, Drug; Humans; Microbial Sensitivity Tests; Povidone-Iodine

In developing countries where systemic antifungal are often unavailable, treatment of filamentous fungi infection as Fusarium is sometimes very difficult to treat. We report the case of a keratomycosis due to Fusarium oxysporum treated by povidone iodine eye drops and oral fluconazole. The diagnosis of abscess in the cornea was retained after ophthalmological examination for a 28-year-old man with no previous ophthalmological disease, addressed to the Ophthalmological clinic at the University Hospital Le Dantec in Dakar for a left painful red eye with decreased visual acuity lasting for 15 days. The patient did not receive any foreign body into the eye. Samples by corneal scraping were made for microbiological analysis and the patient was hospitalized and treated with a reinforced eye drops based treatment (ceftriaxone+gentamicin). The mycological diagnosis revealed the presence of a mold: F. oxysporum, which motivated the replacement of the initial treatment by eye drops containing iodized povidone solution at 1% because of the amphotericin B unavailability. Due to the threat of visual loss, oral fluconazole was added to the local treatment with eye drops povidone iodine. The outcome was favorable with a healing abscess and visual acuity amounted to 1/200th. Furthermore, we noted sequels such as pannus and pillowcase. The vulgarization of efficient topical antifungal in developing countries would be necessary to optimize fungal infection treatment.

Topics: Administration, Oral; Adult; Corneal Ulcer; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Fusarium; Humans; Male; Ophthalmic Solutions; Povidone-Iodine

We report the successful management of a rare case of bilateral post-laser in situ keratomileusis (LASIK) Fusarium oxysporum keratitis and propose a therapeutic strategy. A 19-year-old white man with no systemic diseases was referred to our emergency service 3 days after microkeratome-assisted myopic bilateral LASIK correction. He complained of blurred-vision, photophobia, and ocular pain. Clinical findings (satellite lesions, hypopyon) suggested fungal keratitis. Flaps were immediately lifted and rinsed with povidone-iodine 10%, and intensive topical and systemic and combined antifungal and antibacterial treatment was introduced. Topical cortisone drops were administered after 3 days. Despite initial deterioration of the clinical picture, all symptoms resolved quickly. Polymerase chain reaction indicated F oxysporum. Relapse occurred in the left eye, which was successfully managed. The final uncorrected distance visual acuity was 20/20 in both eyes. Fusarium oxysporum post-LASIK keratitis may occur in the early phase. Prompt diagnosis, interface irrigation with povidone-iodine solution, and intensive long-term treatment contribute to a favorable outcome.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Corneal Ulcer; DNA, Fungal; Drug Therapy, Combination; Eye Infections, Fungal; Fusariosis; Fusarium; Glucocorticoids; Humans; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Myopia; Polymerase Chain Reaction; Postoperative Complications; Povidone-Iodine; Prednisolone; Visual Acuity; Young Adult

The medical records of 39 horses treated for ulcerative keratomycosis over a 10 year period were reviewed. Records were evaluated to determine the medical and/or surgical treatment protocol, visual outcome, globe survival and whether the outcome was influenced by the fungal species isolated. Stromal abscesses and iris prolapses caused by fungi were not included. Twenty of the horses underwent medical treatment only, and 19 horses had combined medical and surgical treatment. Most horses had been treated with topical antibiotics (n = 32) and atropine sulphate (n = 23) prior to referral; topical antifungals had been employed less frequently (n = 14). Fungi were identified by cytology (n = 31), culture (n = 33) and/or surgical histopathology (n = 6). Aspergillus (n = 13) and Fusarium (n = 10) were the most commonly isolated fungi. Miconazole (n = 35) was the most common topical antifungal medication utilised. Median duration of treatment was 48 days (range 31-192 days). Associated bacterial infection (n = 13) was frequently encountered. Visual outcome was favourable in 36/39 (92.3%) eyes. All eyes (20/20) retained vision following medical management only, and 16/19 (84%) retained vision following combined medical and surgical therapy. All medically treated horses (20/20), and 17/19 (89%) of those treated medically and surgically retained their globes. Overall ocular survival was favourable in 37/39 (94.9 %) eyes. Aggressive therapy can result in successful results for equine ulcerative keratomycosis.

Topics: Animals; Anti-Infective Agents, Local; Antifungal Agents; Aspergillus; Corneal Stroma; Corneal Ulcer; Eye Infections, Fungal; Female; Fusarium; Histocytochemistry; Horse Diseases; Horses; Male; Miconazole; Povidone-Iodine; Retrospective Studies; Silver Sulfadiazine; Treatment Outcome; Vision, Ocular

Topical 5% povidone-iodine for the treatment of corneal ulcers was observed in Sierra Leone, West Africa by one of us (D.J.D.). To test the efficacy of topical 5% povidone-iodine for infectious keratitis, experimental Pseudomonas aeruginosa keratitis was induced in 12 rabbits by first abrading the central 3 mm of corneal epithelium. Thirty milliliters of broth of P. aeruginosa strain ATCC 27835 (1.8 x 10(7) viable bacteria) was dropped twice on the wounded cornea. After 22 h, all corneas were clinically infected. Eight rabbits were treated with 5% povidone-iodine solution and four with 0.9% NaCl solution. All were given hourly drops. Twenty-four hours after treatment began, the central 8-mm button of the infected cornea was excised, homogenized, and serial dilutions plated onto MacConkey agar. The total number of viable Pseudomonas organisms was calculated. The treatment group had 5.2 +/- 0.4 CFUs (colony-forming units) per cornea. The control group had 4.8 +/- 0.4 CFUs per cornea (p = 0.11). The clinical scores (Hobden grading system) were 6.9 +/- 1.5 for the treated group and 7.3 +/- 2.5 for the control group (p = 0.74). There was no statistical difference between the treated and control groups. Povidone-iodine (5%) is not effective in the acute treatment of P. aeruginosa keratitis in this rabbit model.

Topics: Animals; Anti-Infective Agents, Local; Colony Count, Microbial; Cornea; Corneal Ulcer; Disease Models, Animal; Eye Infections, Bacterial; Ophthalmic Solutions; Povidone-Iodine; Pseudomonas aeruginosa; Pseudomonas Infections; Rabbits

A new approach of touching betadine directly to infected corneal ulcers in addition to customary treatment is suggested. A report of 35 cases of infected corneal ulcers and keratitis where it was done is studied.

Topics: Administration, Topical; Corneal Ulcer; Humans; Povidone; Povidone-Iodine; Time Factors

Topics: Corneal Ulcer; Female; Humans; Iodine; Male; Povidone; Povidone-Iodine