Letter to the Editor: Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort.
Letter to the Editor: Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort.
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%20致%20the%20编辑：%20对%20Povidone%20Iodine%205%%20的效果%20%20角膜、%20视力、%20和%20主观%20舒适度。
DOI：
10.1097/opx.0000000000001138
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Than,Tammy
中科院分区：
文献类型：
--
作者：
Hartwick,Andrew;Shorter,Ellen;Margolis,Mathew;Johnson,Spencer;Than,Tammy
We read with interest the recent study by Ridder et al. 1 published in the July 2017 issue of Optometry and Vision Science, which reported that application of 5% povidone-iodine ophthalmic solution (PVP-I [Betadine; Alcon, Fort Worth, TX]) in 10 normal subjects caused discomfort, increased corneal epithelial fluorescein staining, and transient changes in visual function (acuity and contrast sensitivity). Previous large-scale studies have reported that ophthalmic PVP-I has good patient tolerability and an excellent safety profile. 2–4 It has been widely utilized in clinics around the globe for decades to disinfect the eye prior to surgery5 and intravitreal injections6 and more recently by some eye-care practitioners for the treatment of adenoviral conjunctivitis. 7 While the results of Ridder and colleagues1 indicate that PVP-I alters vision and damages the corneal epithelium to a greater extent than previously recognized, we would like to point out a couple of potential limitations in their study design. First, in this study, 1 PVP-I was placed on the eye for 2 to 3 minutes and then “washed out” with a single drop of proparacaine hydrochloride. The drug product label provided with Betadine 5% ophthalmic solution (Alcon) states that after this solution “has been left in contact for 2 minutes, sterile saline solution in a bulb syringe should be used to flush the residual prep solution from the cornea, conjunctiva, and the palpebral fornices.” It is not clear from Ridder and colleagues' report1 why a single anesthetic drop was used after Betadine exposure, as opposed to full saline irrigation. Nor are we aware of this approach being typically used in clinical practice. The lack of a thorough saline flush potentially affects the standardization of exposure time, as the single washout drop may have resulted in diluted PVP-I remaining in the eye for an unknown prolonged period. Furthermore, dilution of PVP-I up to 1000-fold can have the paradoxical effect of increasing the concentration of free iodine present due to the complex interactions between iodine, the carrier polymer, the polymer-triiodide complex, and its environment. 8–10 The possible extended contact time of the eye to free iodine may explain why this study reported that the effect on visual acuity was delayed, with a significant decrease occurring at 30 minutes, but not 5 minutes, after Betadine exposure. 1 Second, the order of administration of Betadine and saline was not randomized (all subjects were exposed to Betadine first), and masking of the subjects and clinicians to treatment type was not attempted. 1 The authors state that randomization and masking were not possible because of the expected discomfort and discoloration effects associated with Betadine application. However, other groups have found ophthalmic PVP-I is tolerated with minimal discomfort, 3, 4 and ocular staining could be minimized by using posttreatment irrigation. Therefore, these reasons are not necessarily valid a priori assumptions. A more rigorous design would have been to randomize the treatment order and have the ocular examination and visual assessments performed by a masked clinician. This would eliminate, or at least minimize, the potential for conscious or unconscious bias. We commend the authors for their work in this field and agree with their premise that an ideal antiseptic ophthalmic solution should have broad-spectrum antimicrobial activity while causing negligible effects on corneal epithelial integrity. For clinicians who routinely use Betadine 5% ophthalmic solution, it is encouraging that its effects on patient discomfort, visual function, and corneal fluorescein staining observed in this study1 were relatively transient. However, the …
影响因子：
3.4
作者：
Isenberg, SJ;Apt, L;Campeas, D
通讯作者：
Campeas, D
聚维酮碘 3 分钟暴露时间对于白内障手术的准备是可行的
影响因子：
1.7
作者：
C. L. Nguyen;L. Oh;E. Wong;I. Francis
通讯作者：
I. Francis
影响因子：
9.4
作者：
BERKELMAN, RL;HOLLAND, BW;ANDERSON, RL
通讯作者：
ANDERSON, RL