In vivo assessment of antimicrobial activity and toxicity of repeated 1% povidone-iodine applications vs a single 5% povidone-iodine application.

PURPOSE: To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Prospective, randomized, double-blind study. METHODS: Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. RESULTS: The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application ( P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI ( P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application ( P < .001). CONCLUSIONS: Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.

Pseudallescheria boydii infection of a prosthetic hip joint--an uncommon infection in a rare location.

Pseudallescheria boydii infection of the hip joint was diagnosed 2.5 years after implantation of a prosthetic joint in a woman with rheumatoid arthritis. Cure was achieved with a 10-month course of voriconazole coupled with removal of the prosthesis and repeat surgical debridement. Pseudallescheria boydii is an environmental mold that can cause osteoarticular infection, most often not only after local trauma but also after local injections and surgical procedures. Hip involvement was rarely reported, and this is the first description of a prosthetic joint infection with Scedosporium sp.

Phialemonium curvatum arthritis of the knee following intra-articular injection of a corticosteroid.

Phialemonium curvatum arthritis of the knee developed in a diabetic man following intra-articular injection of a corticosteroid. Cure was achieved with a 6-week course of intravenous amphotericin B deoxycholate. P.curvatum is commonly found in the environment and is often considered a contaminant; yet, its pathogenic potential should be seriously considered in selected patients.