Abstract
Purpose :
The purpose of this study is to report the clinical outcomes of prophylactic povidone-iodine (PPI) for patients at high risk for microbial infections. A secondary outcome is to show if the incidence of infections is significantly reduced with PPI. PI prophylaxis has been demonstrated previously in a study of keratoplasty (KPro) patients. However, nothing has been reported on prophylactic use outside of this indication.
Methods :
A retrospective review (2018-2023) was conducted of patients' status-post ocular surface stem cell transplant or corneal transplant from a single physician. All episodes of infectious keratitis in the review period were documented, and all corneal culture results were included. All eyes received 5% PI ophthalmic solution prophylaxis. The inclusion criteria consisted of eyes that 1) received prophylactic PI after ocular surface stem cell transplantation or Kpro procedure, 2) limbal stem cell deficiency determined by late corneal staining demonstrating a lack of conjunctival epithelium 3) at least 6 months of PPI use. Corneal cultures were obtained and all speciated results were included. The number of infections and infection rates with and without PPI were analyzed using a paired t-test (p ≤ 0.05).
Results :
A total of 31 eyes from 28 patients were included for analysis. Before the initiation of PPI, a total of 51 episodes of infectious keratitis over a cumulative period of 111.48 years were recorded. With PPI, a total of 9 episodes of infectious keratitis over a cumulative period of 51.27 years were recorded. Gram-positive bacteria were the most common result of corneal cultures. Table 1 shows the distribution of various species grown on culture. The total number of infections was 51 was reduced to 11 after PPI. The mean (SD) number of infections per eye was significantly reduced from 0.75 ± (0.95) to 0.13 ± (0.38) infections (p < 0.001). The incidence rate of infectious keratitis before PPI was 0.458 episodes per year, and the incidence rate while on PPI was 0.175 episodes per year. (p < 0.0059).
Conclusions :
This study highlights the potential of PPI in reducing microbial infections in high-risk patients. The findings in this study are consistent with previous research on PPI efficacy in KPRO cases and broaden the clinical utility of this intervention. Further prospective studies are warranted to validate these findings and determine guidelines for PPI in high-risk patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.