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Prospective study to determine the penetration of iodide into the anterior chamber following preoperative application of topical 1.25% povidone-iodine.Hansmann F, Below H, Kramer A, Muller G, Geerling G. Graefes Arch Clin Exp Ophthalmol. 2006 Dec 21; [Epub ahead of print] [abstract only]
"BACKGROUND: Povidone-iodine is currently the agent of choice for pre-operative antisepsis in ophthalmology. Due to experimental and analytical constraints, iodine absorption into the anterior chamber (AC) has not yet been studied. However, knowledge of the details of iodine transfer into the aqueous humor (AH) is critical for risk assessment of local and/or systemic side effects
METHODS: Following a 2-min antisepsis with 1.25% povidone-iodine, the AC of eligible cataract patients was penetrated with a 26-gauge cannula prior to any other intraocular manipulation. To distinguish between the iodine absorbed into the AC and that remaining in the hypodermic delivery syringe, we studied three different groups of specimens: (i) AH from the AC (n=19); (ii) Ringer's solution aspirated through the cannula after penetration into and immediate withdrawal from the AC without subsequent decontamination (n=8); and (iii) Ringer's solution aspirated through the cannula after penetration into and immediate withdrawal from the AC, and subsequent decontamination of its outer surface (n=5). Patients with pre-operative epithelial defects were excluded from the study. To measure iodine absorption, iodide levels in samples were determined chromatographically (ion-pair chromatography) and electrochemically (gold electrode).
RESULTS: There was no difference (P=0.815) between detectable amounts of iodide in groups I and II (median: 24.0 mug/dl and 28.9 mug/dl, respectively). Only group III (median: 5.2 mug/dl) showed a statistically significant lower level of iodide than did groups I or II (P=0.019 and P=0.011, respectively).
CONCLUSIONS: A healthy ocular surface behaves as a barrier to the penetration of iodine into the AC. Any detectable iodide in the AH after antisepsis should therefore be considered harmless."
Effect of topical 1.25% povidone-iodine eyedrops used for prophylaxis of ophthalmia neonatorum on renal iodine excretion and thyroid-stimulating hormone level.Richter R, Below H, Kadow I, Kramer A, Muller C, Fusch C. J Pediatr. 2006 Mar;148(3):401-3. [abstract only]
"The 1% silver nitrate, which has been used for preventing gonococcal conjunctivitis in the neonate, is not effective against Chlamydia trachomatis and may provoke eye irritation. It is not known whether the alternative topical agent, 1.25% povidone-iodine, can influence thyroid function. In this study, no influence of povidone-iodine on thyroid function was observed."
Systemic iodine absorption after preoperative antisepsis using povidone-iodine in cataract surgery-- an open controlled study.Below H, Behrens-Baumann W, Bernhardt C, Volzke H, Kramer A, Rudolph P. Dermatology. 2006;212 Suppl 1:41-6.
"After preoperative conjunctival and periorbital antisepsis with povidone-iodine (PVP-I), the systemic absorption of iodine after cataract surgery was measured to evaluate the risk of thyroid side effects. Five different combinations of PVP-I alone or in combination with PVP-I-free antiseptics were applied to the conjunctiva and periorbital skin. An iodine-free product served as control. Iodide and creatinine in urine were analyzed before intervention and 24 and 48 h postoperatively. Depending on the concentration and application site, 0.3-4.5% of the total applied iodine or 3.6-45.4% of the free iodine were absorbed. The range of urine iodine excretion was between 11.7 and 71.0 mug iodine/g creatinine, depending on the PVP-I concentration and the site of application. The increase in iodine excretion was significant at 24 h postoperatively in trials receiving PVP-I both periorbitally and conjunctivally, depending of the concentration used. Because the iodine absorption is only slight and of doubtful clinical relevance, presurgical conjunctival antisepsis can be achieved with 1.25% PVP-I; so far clinically manifest anamnestic thyroid disorders are excluded. Presently, periorbital skin antisepsis with PVP-I cannot be recommended until data on thyroid metabolism in the population have been collected and evaluated, especially in a region currently or previously deficient in iodine."
New aspects of the tolerance of the antiseptic povidone-iodine in different ex vivo models.Kramer A, Below H, Behrens-Baumann W, Muller G, Rudolph P, Reimer K. Dermatology. 2002;204 Suppl 1:86-91. [abstract only]
"Investigating new possibilities for the application of 1% (v/v) iodophors, povidone-iodine (PVP-I) was better tolerated in the HET-CAM or explant test than 1% (w/v) silver nitrate or tetracycline. After application to the eye, at least 2.6% of used iodine were adsorbed. Therefore PVP-I is more effective than silver nitrate or erythromycin, meaning a possible alternative for the prevention of ophthalmia neonatorum. PVP-I is more active against methicillin-resistant Staphylococcus aureus (MRSA) in a human ex vivo skin model, which results in a complete eradication of S. aureus in the nasal cavity of volunteers after 2 daily applications and will be better tolerated by human nasal cilial epithelium than chlorhexidine. Having the same clinical tolerance as mupirocin, PVP-I is a useful alternative for the antiseptic therapy of germ carriers of MRSA. The synthesis of proteoglycans in articular cartilage of bovine sesamoid bones was increased after application of 5% (v/v) PVP-I without any increase in catabolism revealing possibilities for the use as irrigation solution in the joint."
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