povidone-iodine and Keratitis

To compare povidone-iodine 1.25% ophthalmic solution with topical antibiotics for treatment of bacterial keratitis in areas of the world where use of effective topical antibiotics may not be an option.. Randomized, controlled, investigator-masked clinical trial.. We randomized 172 individuals with bacterial keratitis to topical treatment with povidone-iodine or antibiotics (neomycin-polymyxin B-gramicidin in the Philippines; ciprofloxacin 0.3% in India). Using survival analysis, we compared intervals from start of treatment to "presumed cure" (primary outcome measure, defined as a closed epithelial defect without associated inflammatory signs) and to "recovering" (residual epithelial defect <1 mm. Median interval to presumed cure in the Philippines was 7 days for povidone-iodine and 7 days for neomycin-polymyxin B-gramicidin (95% confidence interval [CI] for difference in median interval, -9.5 to 0.7 days) and in India was 12 days for povidone-iodine and 17 days for ciprofloxacin (95% CI, -35.2 to 3.2 days). Hazard ratio (HR) for presumed cure among those treated with povidone-iodine (vs antibiotics) was 1.46 in the Philippines (95% CI, 0.90-2.36; P = .13) and 1.70 in India (95% CI, 0.73-3.94; P = .22). Comparisons of intervals to recovering and HR for recovering also revealed no significant differences between treatment groups in either country.. There is no significant difference between the effect of topical povidone-iodine 1.25% and topical antibiotics commonly available in the developing world for treatment of bacterial keratitis. Povidone-iodine 1.25%, which is widely available and inexpensive, can be considered for treatment of bacterial keratitis when antibiotic treatment is not practical.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Dose-Response Relationship, Drug; Drug Combinations; Eye Infections, Bacterial; Female; Follow-Up Studies; Humans; Keratitis; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Single-Blind Method; Treatment Outcome

The aim of this monocentric, randomized, comparative, open study was to evaluate the safety of Amukine 0.06% solution (an isotonic hypochloride sodium solution) versus a 5% povidone iodine solution (Bétadine 5% solution for ocular irrigation) in antisepsis before cataract surgery.. One hundred and thirteen patients, aged between 49 and 90 years, were included and split, after randomization, into two groups: one testing Amukine 0.06%, the other testing a 5% povidone iodine solution. For each group, after local anesthesia, the antiseptic procedure consisted of an antisepsis of periocular teguments followed by an eye antisepsis through the instillation of two drops of the tested product in the conjunctival fornices. The safety evaluation was performed by grading superficial punctate keratitis 24 hours after surgery (slit lamp examination after fluorescein instillation). Conjunctival hyperemia scores by examination of the bulbar conjunctiva before the first instillation, immediately before surgery, and 24 hours after surgery were also compared.. One hundred and seven reports were analyzed. Concerning the presence of corneal superficial punctate keratitis 24 hours after surgery, mean scores were not different (0.27 for the Amukine 0.06% group and 0.38 for the povidone iodine group; p=0.27 Mann Whitney test). The observations did not show a different progression of conjunctival hyperemia depending on the treatment group (p=0.65 (immediately after application) and p=0.52 (after 24 hours); Mann Whitney test).. In this study, the ocular safety of Amukine 0.06% solution was not different from a 5% povidone iodine solution. Therefore, Amukine 0.06% is a new interesting approach to surgical antisepsis in ophthalmology and an alternative in case of iodine allergy.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents, Local; Antisepsis; Cataract Extraction; Conjunctiva; Disinfectants; Eye; Female; Humans; Hyperemia; Iodophors; Keratitis; Male; Middle Aged; Postoperative Complications; Povidone-Iodine; Preoperative Care; Safety; Sodium Hypochlorite; Time Factors

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

Contact lens (CL) wear is a risk factor for the acquisition of microbial keratitis. Accordingly, compliance to manufacturers' recommended hygiene and disinfection procedures are vital to safe (CL) use. In this study we evaluated a novel povidone-iodine (PI) (CL) disinfection system (cleadew, Ophtecs Corporation, Japan) against a range of bacterial, fungal and Acanthamoeba.. Antimicrobial assays were conducted according to ISO 14729 using the recommended strains of bacteria and fungi, with and without the presence of organic soil. Regrowth of bacteria and fungi in the disinfection system was also examined. The activity on biofilms formed from Stenotrophomonas maltophilia and Achromobacter sp. was evaluated. Efficacy against A. castellanii trophozoites and cysts was also investigated.. The PI system gave >4 log. The PI system effective against a variety of pathogenic microorganisms under a range of test conditions. Strict compliance to recommended CL hygiene procedures is essential for safe CL wear. The use of care systems such as PI, with broad spectrum antimicrobial activity, may aid in the prevention of potentially sight threatening microbial keratitis.

Topics: Anti-Infective Agents, Local; Bacteria; Biofilms; Contact Lens Solutions; Contact Lenses; Disinfection; Eye Infections, Bacterial; Humans; Keratitis; Povidone-Iodine

Topics: Anti-Bacterial Agents; Eye Infections, Bacterial; Humans; Keratitis; Povidone-Iodine; Prospective Studies

To describe the incidence, causes, risk factors, and preventive strategies regarding an outbreak of diffuse lamellar keratitis (DLK).. Between March and October 2007, an epidemic of DLK was detected in one center. During this period, 6 surgeons performed 1161 LASIK or flap lift procedures. From March to August 2007, data were retrospectively collected corresponding to pre- and postoperative clinical findings and environmental risk factors related to the operating room, auxiliary staff, sterilization, and surgical equipment (phase 1). Incidence and distribution of cases are described. From August to October 2007, a prospective epidemiological study was completed, analyzing the clinical and intraoperative variables associated with the outbreak (phase 2). A plan of action was applied covering a wide range of possible causes.. During phase 1, 25.79% of eyes developed DLK. A greater incidence was found in eyes operated on Mondays and a smaller incidence was found when povidone-iodine was used for disinfection of the instruments. Actions taken by the staff to stop the outbreak had no effect, and epidemiologists designed a strategy aimed at addressing all possible weak points and the prospective study for detecting causes. The incidence decreased to 1.87% and a weak significant association was found for sex, atopy, drug allergies, spherical equivalent refraction, and mechanical microkeratome.. Strategies aimed at addressing all possible etiological factors can stop an epidemic of DLK even when a single cause has not been isolated.

Topics: Adult; Anti-Infective Agents, Local; Corneal Stroma; Disease Outbreaks; Disinfection; Endotoxins; Female; Humans; Incidence; Keratitis; Keratomileusis, Laser In Situ; Lasers, Excimer; Male; Middle Aged; Povidone-Iodine; Prospective Studies; Retrospective Studies; Risk Factors; Sex Factors; Spain; Sterilization; Surgical Flaps; Young Adult

Fungal infection is rarely investigated in keratitis. The authors report five cases of fungal keratitis observed at the le Dantec University Teaching Hospital of Dakar, Senegal, involving two males and three females. Diagnosis was made by examination of smears and cultures of corneal scrapings revealing Candida albicans isolated in four patients and Acremonium strictium in another after 2 or 12 weeks of treatment with antibiotics, antivirals, or steroids. Povidone iodine 2.3% concentrated eye drop was used alone or with an azole for 4 a mean of weeks. All patients presented corneal scars. Fungal keratitis must be considered in presence of torpid corneal ulcer and corneal scraping must be systematically done. Topical povidone iodine alone or associated with azole may be an alternative fungal keratitis treatment in intertropical areas.

Topics: Administration, Topical; Adult; Aged; Anti-Infective Agents, Local; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Middle Aged; Povidone-Iodine

To determine the efficacy of 0.02% polyhexamethylene biguanide and 1% povidone iodine in experimental keratitis.. Aspergillus fumigatus keratitis was induced by corneal intrastromal injection of spores in 24 healthy rabbits that were randomly divided into four groups of six rabbits each. Drugs used were 5% natamycin (standard antifungal), 0.02% polyhexamethylene biguanide (PHMB) (test drug), 1% povidone iodine (test drug), and 0.5% hydroxypropylmethyl cellulose (HPMC) (control).. The average healing times of the ulcer were 21.5 +/- 3.08 days with 5% natamycin, 27.8 +/- 2.28 days with 0.02% PHMB, 36.4 +/- 2.57 days with 1% povidone iodine, and 38.2 +/- 4.74 days with 0.5% HPMC. While no corneal perforations occurred with natamycin treatment, one perforation was noted with PHMB, three perforations were noted with povidone iodine, and five perforations were noted with controls.. Polyhexamethylene biguanide (0.02%) is a moderately effective drug for experimental Aspergillus keratitis, but 1% povidone iodine is not effective.

Topics: Animals; Anti-Infective Agents, Local; Aspergillosis; Aspergillus fumigatus; Biguanides; Corneal Stroma; Disinfectants; Drug Evaluation; Eye Infections, Fungal; Keratitis; Natamycin; Ophthalmic Solutions; Povidone-Iodine; Prospective Studies; Rabbits; Random Allocation

To induce diffuse lamellar keratitis (DLK) and investigate the potential causative agents in an animal model.. Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.. In 70 eyes of 35 Dutch Belted rabbits, a corneal flap was cut and the interface randomly exposed to 1 of 7 substances: Pseudomonas aeruginosa endotoxin, 1 of 2 Staphylococcus aureus exotoxins, meibomian gland secretion, povidone-iodine 10%, Palmolive Ultra soap, and Klenzyme soap. Slitlamp examinations were performed 1, 3, 5, and 7 days postoperatively. The DLK was staged from 1 to 4. On day 7, the rabbits were killed and the eyes enucleated and processed for histopathologic examination.. At the end of the study, 54 eyes (46 exposed, 8 control) were available for evaluation. The 8 eyes studied concurrently in the control group remained clear and did not show interface inflammation. Thirty-one of 46 eyes (67%) treated with the various test substances developed DLK. The highest DLK rates were found with the cleaning soap Palmolive Ultra (100%; P =.022) and P. aeruginosa lipopolysaccharide endotoxin (90%; P =.026).. Interface inflammation was consistently induced in the animal model. All 7 agents caused DLK in at least some eyes. The histopathologic evaluation showed the morphologic profile of the marked inflammatory cellular reaction that occurred in almost all the specimens.

Topics: Animals; Biological Factors; Bodily Secretions; Corneal Stroma; Exotoxins; Female; Keratitis; Lipopolysaccharides; Meibomian Glands; Models, Animal; Povidone-Iodine; Pseudomonas aeruginosa; Rabbits; Soaps; Staphylococcus aureus; Surgical Flaps

To compare the antibacterial effect of povidone-iodine (PI) with that of ofloxacin in an experimental model of bacterial keratitis.. Staphyloccocal keratitis was induced in 21 eyes of Dutch Belted rabbits by intrastromal inoculation of approximately 280 organisms of Staphylococcus aureus. Six hours later, the animals were divided in four groups treated topically with saline 0.9%, Betadine 10%, Betadine 0.5% or Ofloxacin 0.3% (2 gtt every 30 min for 8 h). The central 8-mm cornea was excised, washed and homogenized. Colony counts were performed on serial 10-fold dilutions plated on blood and brain infusion agar and incubated overnight.. Colony-forming units per cornea were 7.4x10(7) for the saline group compared to 8.2x10(7) for PI 10% (P>0.5), 4.3x10(7) for PI 0.5% (P<0.01) and no organisms for ofloxacin 0.3%.. Betadine 0.5% demonstrates a statistically significant bactericidal effect compared with untreated staphyloccocal keratitis in our experimental model. Ofloxacin has superior antibacterial effect under the conditions studied. Further improvements in the povidone-iodine formulation are warranted prior to consideration for human keratitis.

Topics: Animals; Anti-Infective Agents; Colony Count, Microbial; Cornea; Disease Models, Animal; Eye Infections, Bacterial; Iodophors; Keratitis; Male; Ofloxacin; Ophthalmic Solutions; Povidone-Iodine; Rabbits; Staphylococcal Infections; Staphylococcus aureus