The Role Of Topical Povidone-Iodine In The Management Of Infectious Keratitis: A Pilot Study

The aim of this prospective explorative study was to evaluate the safety and the effectiveness

of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for

pathogen identification and susceptibility testing in patients with infectious keratitis (IK).

Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona,

corneal

swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was

administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate

depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a

specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL).

Twentyfive

eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1,

ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027

and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in

those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures

(n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial

therapy.

The administration of 0.66% PVP-I during the time-to-result period seems to be a safe

strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it

showed to be effective in eyes with a Gram-positive bacterial infection.