Prospective, Randomized Clinical Trial of Povidone-Iodine 1.25% Solution Versus Topical Antibiotics for Treatment of Bacterial Keratitis.

PURPOSE: To compare povidone-iodine 1.25% ophthalmic solution with topical antibiotics for treatment of bacterial keratitis in areas of the world where use of effective topical antibiotics may not be an option. STUDY DESIGN: Randomized, controlled, investigator-masked clinical trial. METHODS: We randomized 172 individuals with bacterial keratitis to topical treatment with povidone-iodine or antibiotics (neomycin-polymyxin B-gramicidin in the Philippines; ciprofloxacin 0.3% in India). Using survival analysis, we compared intervals from start of treatment to "presumed cure" (primary outcome measure, defined as a closed epithelial defect without associated inflammatory signs) and to "recovering" (residual epithelial defect <1 mm2 with only minimal inflammation). RESULTS: Median interval to presumed cure in the Philippines was 7 days for povidone-iodine and 7 days for neomycin-polymyxin B-gramicidin (95% confidence interval [CI] for difference in median interval, -9.5 to 0.7 days) and in India was 12 days for povidone-iodine and 17 days for ciprofloxacin (95% CI, -35.2 to 3.2 days). Hazard ratio (HR) for presumed cure among those treated with povidone-iodine (vs antibiotics) was 1.46 in the Philippines (95% CI, 0.90-2.36; P = .13) and 1.70 in India (95% CI, 0.73-3.94; P = .22). Comparisons of intervals to recovering and HR for recovering also revealed no significant differences between treatment groups in either country. CONCLUSIONS: There is no significant difference between the effect of topical povidone-iodine 1.25% and topical antibiotics commonly available in the developing world for treatment of bacterial keratitis. Povidone-iodine 1.25%, which is widely available and inexpensive, can be considered for treatment of bacterial keratitis when antibiotic treatment is not practical.

A mysterious case of bilateral stromal keratitis

OBJECTIVES: To describe a rare case of bilateral stromal keratitis and demonstrate the effectiveness of penetrating keratoplasty in the management of toxocara keratitis. METHOD: This is a case report. RESULTS: A 53-year-old male farmer had a 10-month history of bilateral corneal opacity, photophobia, redness, foreign body sensation, and eye pain. The diagnosis was central microbial keratitis with the following etiologies considered: Epstein-Barr virus, herpes simplex, fungal, syphilis, tuberculosis (TB), myobacteria other than TB, and acanthamoeba. Despite treatment with topical steroids and antibiotics, both eyes worsened. Penetrating keratoplasty markedly improved the patient's visual acuity. Histopathology of the left corneal button revealed toxocara keratitis. CONCLUSION: Good history taking, complete systemic and ocular examinations, and a histopathology of the corneal tissues are vital to the diagnosis of toxocara keratitis. Penetrating keratoplasty was shown to be effective in its management. Emphasis is given on prevention to decrease the incidence of the disease.

Dry heat sterilization of ophthalmic instruments using a commercially available convection broiler

This study is proposed as an alternative method of sterilization in developing countries Purpose: To determine the efficacy of using a commercially available convection broiler in sterilization of ophthalmic surgical instruments Methods: Surgical ophthalmic instruments were contaminated artificially with Staphylococcus epidermidis, Pseudomonas aeruginosa, and Aspergillus. The instruments were subjected to heat sterilization using the convection broiler at different temperature settings. After which, the instruments were cultured with appropriate media to determine contamination Results: 15 minutes heat sterilization at 260 degrees centigrade was enough to sterilize the contaminated ophthalmic surgical instruments Conclusion: Heat sterilization using a convection broiler provide a cheaper yet effective method of sterilization. (Author)

A controlled trial of povidone-iodine to treat infectious conjunctivitis in children.

PURPOSE: To report the efficacy of povidone-iodine as a treatment for conjunctivitis in pediatric patients. DESIGN: Double-masked, controlled, prospective clinical trial. METHODS: In an ophthalmology clinic in a general hospital in Manila, Philippines, 459 children (mean [SD] age 6.6 [6.6] years; range, 7 months-21 years) with acute conjunctivitis were studied. Infected eyes were cultured for bacteria and underwent immunofluorescent testing for Chlamydia trachomatis. Viral conjunctivitis was diagnosed if bacterial cultures were negative and diagnostic criteria were met. Subjects were alternated to receive povidone-iodine 1.25% or neomycin-polymyxin-B-gramicidin ophthalmic solution, one drop 4 times daily in the affected eye. Ocular inflammation was evaluated daily by the family or patient and weekly by an ophthalmologist. The main outcome measures were days until cured and proportion cured after 1 and 2 weeks of treatment. RESULTS: Despite adequate statistical power (power >80% for a 1-day difference and P <.05), there was no significant difference between treatment groups regarding the number of days to cure or proportion cured at 1 or 2 weeks whether caused by bacteria or virus (P =.133-.824 for the four comparisons). After 1 week of treatment, povidone-iodine cured marginally more chlamydial infections than the antibiotic (P =.057). By 2 weeks, fewer chlamydial infections were cured than those of viral or bacterial etiology (P =.0001). The younger the patient, the faster their conjunctivitis resolved (R = 0.13, P =.013). CONCLUSIONS: Povidone-iodine 1.25% ophthalmic solution was as effective as neomycin-polymyxin B-gramicidin for treating bacterial conjunctivitis, somewhat more effective against chlamydia, and as ineffective against viral conjunctivitis. Povidone-iodine ophthalmic solution should be strongly considered as treatment for bacterial and chlamydial conjunctivitis, especially in developing countries where topical antibiotics are often unavailable or costly.