Ocular Surface And Tear Film Changes Following Repeated Povidone-Iodine Exposure During Intravitreal Injections: A Prospective Cohort Study
Published 2026 - 44th Congress of the ESCRS
Reference: PP25.02 | Type: Poster | DOI: 10.82333/amdz-8239
Authors: Dr Ivanka Maduna* 1 , Dr Loren Bajto 2 , Dr Andrijana Kopić 3 , A/Prof. Dubravka Biuk 3 , Dr Marija Jelić-Vuković 3 , Dr Josip Barać 3 , Dr Stipe Vidović 4 , A/Prof. Suzana Matić 3
1Health center of Osijek-Baranja county,Osijek,Croatia;Faculty of Medicine,Josip Juraj Strossmayer University of Osijek,Osijek,Croatia, 2Polyclinic Vaš Pregled,Zagreb,Croatia, 3Department of Ophthalmology,University Hospital Center Osijek,Osijek,Croatia;Faculty of Medicine,Josip Juraj Strossmayer University of Osijek,Osijek,Croatia, 4Department of Ophthalmology,University Hospital Center Osijek,Osijek,Croatia
Purpose
Povidone-iodine antisepsis is essential for preventing endophthalmitis in intraocular procedures; however, repeated exposure may affect ocular surface integrity. This study aimed to evaluate short-term subjective and objective ocular surface changes over a 30-day period following repeated povidone-iodine exposure.
Setting
This observational prospective case-control study was conducted at the Department of Ophthalmology, University Hospital Center Osijek.
Methods
Thirty patients undergoing unilateral repeated intravitreal anti-VEGF injections were prospectively enrolled. A comprehensive ophthalmological examination was performed before injection and on days 1, 7, and 30 post-procedure. Evaluations included the Schirmer test, tear film break-up time (TBUT), corneal fluorescein staining, grading of conjunctival injection, and Ocular Surface Disease Index (OSDI) questionnaire. The untreated fellow eye served as a control. Changes over time and inter-eye differences were analyzed.
Results
Thirty patients were included, 47% were male. Baseline Schirmer, TBUT and OSDI showed no inter-eye differences and no corneal staining or conjunctival injection was present. TBUT values in treated eyes were significantly lower than in control eyes on days 1 and 7 after the procedure, with no difference at day 30 (P=0.04; P=0.02; P=0.23, respectively). OSDI scores significantly increased from baseline on days 1 and 7 (P<0.001; P=0.002, respectively) and returned to baseline levels by day 30 (P=0.35). Fluorescein staining and conjunctival injection significantly increased in treated eyes on days 1 and 7 compared with baseline and control eyes (P<0.001), with no significant differences between eyes or versus baseline at day 30 (P=0.08).
Conclusions
Repeated povidone-iodine exposure during intravitreal anti-VEGF injections induces transient ocular surface disturbance characterized by increased dry eye symptoms, reduced TBUT, corneal epithelial damage, and conjunctival hyperemia. Changes peak within the first week and resolve by one month. Although recovery occurs within one month, cumulative long-term exposure may affect patient comfort. Awareness of post-injection ocular surface alterations is important, and prophylactic ocular surface management may improve patient comfort and potentially support adherence to long-term therapy.