Intravitreal Injection of 1.25% Povidone Iodine Followed by Vitrectomy Using 0.025% Povidone Iodine Irrigation for Treating Endophthalmitis

Abstract

Purpose: To investigate the safety and effectiveness of intravitreal injection (IVI) of 1.25% povidone iodine (PI) followed by vitrectomy using 0.025% PI irrigation for treating endophthalmitis.

Methods: Prospective case series study. Nine eyes of 8 patients with postoperative or endogenous endophthalmitis treated at the Nihon University Hospital between April 2015 and October 2017 were studied. First, IVI of 0.1 mL/1.25%PI was conducted, followed by anterior chamber irrigation and vitrectomy using 0.025%PI irrigation solution. Corneal epithelial damage, anterior chamber inflammation, and vitreous inflammation were assessed and fundus examinations were performed, using a slit-lamp microscope and indirect ophthalmoscopy. A specular microscope, Goldmann perimetry, and electroretinography (ERG) were also used.

Results: In all but case 7, endophthalmitis resolved rapidly and good visual acuity was maintained. No adverse events were noted. Furthermore, the perioperative ERG showed improvements in the oscillatory potentials amplitudes on ERG and flicker ERG, as well as in the implicit time of the a-wave, suggesting functional recovery in the retinal outer and inner layers after therapy.

Conclusions: IVI of PI followed by vitrectomy was thought to be a safe and effective treatment for endophthalmitis.

Translational relevance: We succeeded in proving the clinical safety of IVI of PI followed by vitrectomy with PI irrigation as well as previous experimental reports. PI is available in world widely, therefore this method will be optimal treatment for endophthalmitis.

Keywords: electroretinogram; endophthalmitis; intravitreal injection; povidone iodine; vitrectomy.

Figure 1

How to make 1.25%/0.1 mL of PI. First, 0.1 mL of 10%PI, which is an undiluted solution of PI, is taken into a 1-mL syringe. The needle is then exchanged for a new one, and 0.7 mL of saline solution is added, resulting in 0.8 mL of the solution. The solution is mixed well to achieve a uniform concertation. This is further reduced to 0.1 mL (i.e., to a 0.1-mL volume of 1.25%PI) which is administered by IVI using a 30-G needle.

Figure 2

Comparisons of the amplitudes (left) and the implicit times (right) in each ERG component before IVI and after surgery in five affected eyes. The amplitudes of OPs and the flicker ERG after surgery were significantly higher than those before IVI. The amplitudes in other components did not show significant changes after surgery. The implicit time of the a-wave was shorter after than before IVI. The implicit times for other components did not show significant changes after surgery. pre: pre-IVI, post: post-surgery. Bar = standard deviation, *P < 0.05.

Figure 3

Comparisons of the amplitudes (left) and the implicit times (right) in each ERG component between the affected eye and the healthy fellow eye after surgery in five cases. Neither the amplitude nor the implicit time showed significant differences in any of the components between the affected eye and the healthy fellow eye. Bar = standard deviation.