Effectiveness of Intraoperative 0.25% Povidone-iodine Irrigation during Cataract Surgery for Prevention of Postoperative Endophthalmitis

Wipada Sererat

doi:10.64960/srimedj.v41i4.271370

Authors

Wipada Sererat Division of Ophthalmology, Roi Et Hospital, Mueang District, Roi Et Province, Thailand 45000

DOI:

https://doi.org/10.64960/srimedj.v41i4.271370

Keywords:

cataract, povidone-iodine, postoperative endophthalmitis, cataract surgery

Abstract

Background and objective: Cataract is a major cause of treatable blindness, while postoperative endophthalmitis, although rare, is a severe complication. The objective of this study was to evaluated the safety and clinical outcomes of intraoperative 0.25% povidone-iodine irrigation during cataract surgery for prevention of postoperative endophthalmitis.

Methods: A retrospective review of medical records was conducted in patients who underwent cataract surgery between January 1, 2021, and March 30, 2025, with intraoperative irrigation using 0.25% povidone-iodine solution. Data were analyzed using descriptive statistics.

Results: A total of 838 patients were included with mean age 66.9 ± 9.6 years, most were female (56.9%). The majority underwent phacoemulsification with intraocular lens implantation (97.6%). On postoperative day 1, anterior chamber inflammation graded 1+, 2+ and 3+ were observed in 28.6%, 60.0% and 11.4%, respectively, decreasing to trace in 99.5% within 7 days. The mean time to absence of inflammation was 32.9 ± 6.9 days. No postoperative endophthalmitis was detected during mean follow-up of 9.9 ± 6.0 months. Postoperative visual acuity of 6/12 or better was achieved in 77% of patients after 6 months of surgery.

Conclusions: The intraoperative use of 0.25% povidone-iodine solution during cataract surgery demonstrated a favorable safety profile and acceptable clinical outcomes, with no cases of postoperative endophthalmitis observed during the follow-up period. However, as this study did not include a comparison group, it could not determine whether the preventive effect against postoperative endophthalmitis differed from that of no prophylactic use or other preventive approaches.

References

GBD 2019 Blindness and Vision Impairment Collaborators. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: An analysis for the Global Burden of Disease Study. Lancet Glob Health 2021;9(2):e144–60. doi:10.1016/S2214-109X(20)30489-7.

Zaharia AC, Dumitrescu OM, Rogoz RE, Dimirache AE, Zemba M. Preoperative antisepsis in ophthalmic surgery (a review). Romanian J Ophthalmol 2021;65(2):120–4. doi:10.22336/rjo.2021.25.

Tan EL, Johari NH. Comparative in vitro evaluation of the antimicrobial activities of povidone-iodine and other commercially available antiseptics against clinically relevant pathogens. GMS Hyg Infect Control 2021;16:Doc05. doi:10.3205/dgkh000376.

Grzybowski A, Kanclerz P, Myers WG. The use of povidone-iodine in ophthalmology. Curr Opin Ophthalmol 2018;29(1):19–32. doi:10.1097/ICU.0000000000000437.

Shimada H, Nakashizuka H. Cataract surgery by intraoperative surface irrigation with 0.25% povidone iodine. J Clin Med 2021;10(16):3611. doi:10.3390/jcm10163611.

Matsuura K, Miyazaki D, Sasaki SI, Yakura K, Inoue Y, Sakamoto M. Effectiveness of timely intraoperative iodine irrigation during cataract surgery. Jpn J Ophthalmol 2016;60(6):433–8. doi:10.1007/s10384-016-0471-z.

Gadavi BN, Pai A, Kamath MA, Bhosale DA, Gohel DJ. Siep’s test: A novel test for checking wound integrity in small-incision cataract surgery. Indian J Ophthalmol 2022;70(11):3974–6. doi:10.4103/ijo.IJO_1585_22.

Briceno-Lopez C, Burguera-Giménez N, García-Domene MC, Díez-Ajenjo MA, Peris-Martínez C, Luque MJ. Corneal edema after cataract surgery. J Clin Med 2023;12(21):6751. doi:10.3390/jcm12216751.

Miura M, Inomata T, Nakamura M, Sung J, Nagino K, Midorikawa-Inomata A, et al. Prevalence and characteristics of dry eye disease after cataract surgery: A systematic review and meta-analysis. Ophthalmol Ther 2022;11:1309-32. doi:10.1007/s40123-022-00513-y.

Ajlan RS, Dalla S, Parikh RJ, Pfannenstiel MM, Champion MT, Rahman MA, et al. Topical povidone iodine 2.5% versus 5% for endophthalmitis prophylaxis during intravitreal injections. J Ophthalmol 2025;2025:6629976. doi:10.1155/joph/6629976.

Liu N, Yang X, Guo D, Wang Q, Zhang J, Wang X. Analysis of the effect of infection control strategy in preventing and controlling infectious endophthalmitis after cataract surgery. BMC Ophthalmol 2025;25(1):455. doi:10.1186/s12886-025-04291-6.

Das T, Belenje A, Joseph J, Pandey S, Pandya D, Behera UC, et al. Clinical and microbiological characteristics of multidrug-resistant acute bacterial endophthalmitis after cataract surgery. Endophthalmitis Management Study Report # 8. Retina 2026;46(3):457–64. doi:10.1097/IAE.0000000000004696.

Stringham JD, Relhan N, Miller D, Flynn HW. Trends in fluoroquinolone nonsusceptibility among coagulase-negative staphylococcus isolates causing endophthalmitis, 1995-2016. JAMA Ophthalmol 2017;135(7):814–5. doi:10.1001/jamaophthalmol.2017.1826.

Flaxel CJ, Smith JR, Jain N, Kim LA, Kim SJ, Maguire MG, et al. Is there evidence for changes in antibiotic resistance of microorganisms causing postcataract surgery endophthalmitis: A systematic review. BMJ Open Ophthalmol 2025;10(1):e001935. doi:10.1136/bmjophth-2024-001935.

Feng J, Jan C, Peng Y, He M, An L, Zhan L, et al. Retrospective analysis of cataract surgery outcomes in China from 2009 to 2018: From a national registry system data. BMJ Open 2023;13(4):e070989. doi:10.1136/bmjopen-2022-070989.

Shi SL, Yu XN, Cui YL, Zheng SF, Shentu XC. Incidence of endophthalmitis after phacoemulsification cataract surgery: A meta-analysis. Int J Ophthalmol 2022;15(2):327–35. doi:10.18240/ijo.2022.02.20.