Safety And Efficacy Of Abbreviated Povidone-Iodine Contact Time In Cataract Surgery: A Retrospective Analysis Of 2000 Consecutive Cases

To evaluate the safety and efficacy of abbreviated povidone-iodine (PVI) contact time (45-60 seconds) compared to the conventional 3-minute protocol in preventing postoperative endophthalmitis following phacoemulsification.

Single-center tertiary eye care institution.

Retrospective cohort study of 2000 consecutive eyes undergoing phacoemulsification with IOL implantation. All surgeries were performed by a single surgeon using 5% PVI applied for 45-60 seconds. Primary outcome was endophthalmitis incidence. Secondary outcomes included TASS, cystoid macular edema (CME), corneal edema, IOL dislocation, and BCVA. Follow-up was performed at day 1, week 1, month 1, and month 3.

Mean age was 67.2±9.8 years (54.8% female). Comorbidities included diabetes (24.8%), hypertension (45.2%), and glaucoma (13.2%). Macular pathology was present in 19.9%. Zero cases of endophthalmitis occurred (0/2000, 0.00%; 95% CI: 0.00-0.18%), within the literature range of 0.01-0.10%. TASS incidence was 0%. CME occurred in 57 eyes (2.85%) at 1 month, with 16 (0.80%) persistent at 3 months. Intraoperative complications occurred in 30 eyes (1.50%). Persistent corneal edema and IOL dislocation each occurred in 4 eyes (0.20%). All rates were within published ranges. Mean BCVA improved from 0.74±0.28 to 0.34±0.21 logMAR (p<0.001). In eyes without macular pathology, 93.1% achieved ≥20/25 at 1 month.

Abbreviated PVI contact time (45-60 seconds) demonstrates comparable safety to the conventional 3-minute protocol, with zero endophthalmitis in 2000 surgeries. This protocol may reduce corneal toxicity and improve surgical efficiency without compromising infection prophylaxis.