Effectiveness of 1.25 % povidone-iodine combined with topical levofloxacin
against conjunctival flora in intravitreal injection.
Author(s): Ikuno Y, Sawa M, Tsujikawa M, Gomi F, Maeda N, Nishida K.
Affiliation(s): Department of Ophthalmology E7, Osaka University Graduate School of Medicine, 2-2
Yamadaoka, Suita, Osaka 5650871, Japan. ikuno@ophthal.med.osaka-u.ac.jp
Publication date & source: 2012, Jpn J Ophthalmol. , 56(5):497-501
PURPOSE: To compare the effect of a reduced concentration (1.25 %) of
povidone-iodine (PI) eye drops, combined with 0.5 % topical levofloxacin (LVFX),
with that of the standard of care (5 % PI) on conjunctival flora before
intravitreal injections (IVT).
METHODS: A prospective, randomized, single-blind clinical trial. One hundred eyes
from 100 patients who underwent IVT were included. Eyes were randomly assigned to
two groups and underwent different preparatory procedures before therapeutic IVT.
LVFX drops were instilled three times every 5 min and then either 1.25 % PI drops
were instilled three times every few minutes in group A or 5 % PI drops were
instilled three times every few minutes in group B, the control. Conjunctival
flora and the injection needles were collected for culture both before and after
preparation. The number of positive cultures, the species isolated, and the
minimum inhibitory concentrations (MIC) of the antibiotics were assessed.
RESULTS: The pretreatment culture was positive for 45 eyes (86.5 %) in group A (n
= 52) and for 37 eyes (77.1 %) in group B (n = 48). After the preparatory
procedure, the cultures were positive for 25 eyes (48.1 %) in group A and for 27
eyes (56.3 %) in group B (P = 0.43). After preparation, the number of positive
cultures decreased by 46.7 % in group A and by 33.4 % in group B (P = 0.48). No
needle samples were contaminated in either group. The most common isolate in both
groups after preparation for surgery was Propionibacterium acnes. Among the
different antibiotics, vancomycin and oxacillin had the lowest MIC >90 for
overall isolates.
CONCLUSIONS: 1.25 % PI with LVFX is as effective as 5 % PI. P. acnes was the most
common conjunctival flora detected. Vancomycin has been confirmed as the best
choice for treating infectious endophthalmitis after IVT.
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